OpenNotes at Geisinger Health System

About Geisinger

Geisinger Health System is an integrated health network that serves 2.6 million people in central and northeastern Pennsylvania. Geisinger uses an Epic electronic health record and patient portal.

As one of three initial OpenNotes study sites, Geisinger began sharing visit notes in 2010 with 24 primary care physicians and over 8,000 patients. By December 2013, over 1,300 Geisinger physicians and advanced practitioners were routinely sharing their notes with over 200,000 patients. Geisinger currently limits the program to outpatient visits, but it expects to expand to inpatient stays and emergency room visits in 2014.

Key features

  • Geisinger includes only notes signed after the open notes start date.
  • Clinicians can exclude patients. A patient excluded by one provider cannot view any provider notes. Geisinger currently excludes fewer than 1% of its patients.
  • To reduce concerns about parents viewing notes of adolescents and young adults, Geisinger excludes patients between ages 12 and 17.
  • Geisinger gives patients’ caregivers access to their notes online via a separate “proxy” account.

Who is sharing notes?

  • Over 75% of physicians, nurse practitioners and physician assistants currently share their notes with patients. By the end of 2014, over 85% of providers will share their notes.
  • Specialty department chairs determine participation in OpenNotes. Although some departments choose to make participation mandatory, others permit clinicians to opt out of the program.
  • Some departments choose to pilot OpenNotes with a few physicians before expanding the program.
  • All medical residents and fellows participate in OpenNotes.
  • When multiple providers (e.g., advanced practitioner and attending, or resident and attending) sign the notes, both providers must participate in OpenNotes for the patient to view the progress notes online.

How are notes being shared?

  • Patients access notes via a secure online patient portal called MyGeisinger.

How did Geisinger introduce open notes to patients and clinicians?

  • Presentations by clinical champions at departmental meetings to educate staff on Geisinger’s OpenNotes initiatives.

Lessons learned from implementation:

  • Engage departments and physician leaders directly through face-to-face presentations.
  • Use evidence of the positive impact sharing notes has on patients and the negligible burden it places on providers to make the case for adopting open notes.
  • Lower provider anxiety by assuring them it is ok to exclude patients at any time, and refraining from suggesting changes to their current documentation practices. Emphasize that most patients value seeing their documentation as it is currently written. If clinicians feel patients cannot handle their unedited notes, advise them to exclude those patients.
  • Use early adopters to reassure other providers that open notes represents a negligible burden.
  • Start preparing the technology early; it takes time for technology staff to make notes readable on smartphones and for physicians to exclude specific patient groups.
  • Set a “rollout” schedule to avoid overwhelming technology staff and to ensure the application develops in a stable manner.
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