As the OpenNotes movement spreads, it offers important opportunities to learn from many health care professionals and health systems, as well as millions of patients. We’re collaborating closely with researchers across the country and around the world to understand the effects of fully transparent medical care on communication, engagement, safety, costs, and the overall quality of care.
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Patients Typing Their Own Visit Agendas Into an Electronic Medical Record: Pilot in a Safety-Net Clinic
Collaborative agenda setting is a communication skill that helps patients identify concerns early in the clinic visit, possibly diminishing the number of “Oh, by the way” items at the end of visits, and increasing patient satisfaction. Agenda setting, however, is often limited by time constraints.
Electronic medical records (EMRs) offer patients access to their medical data, including doctors’ notes, and have the capability to facilitate increased patient involvement in their health care and also contribute to their health data. OpenNotes is a national initiative, not a software program, that invites patients to review their visit notes written by their doctors, nurses, or other clinicians. Existing OpenNotes research shows enthusiasm among both patients and clinicians, but this is the first Open-Notes study of cogeneration of clinic notes.
Patients have unprecedented online access to their medical records. More than 6 million Americans can now read their doctors’ notes via patient portals, and continued rapid growth is likely. Sharing notes with patients may yield important health benefits, including increased patient empowerment and improved medication adherence. Seeing written information, including notes, helps patients remember the plan of care, reinforces patients’ positive behaviors, and strengthens the patient–doctor alliance.
Patient Portals that allow viewing of clinical notes and hospital discharge summaries: the University of Washington OpenNotes implementation experience
Many healthcare organizations are striving to improve patient engagement by facilitating patient access to clinical notes in the electronic health record (EHR) via patient portals. The University of Washington Health System (UW Medicine) in Seattle, WA, was an early participant in research on patient portals as one of the three OpenNotes study sites.
Patients and families as teachers: a mixed method assessment of collaborative learning model for medical error disclosure and prevention
ABSTRACT Background Despite growing interest in engaging patients and families (P/F) in patient safety education, little is known about how P/F can best contribute. We assessed the feasibility and acceptability of a patient–teacher medical error disclosure and prevention training model. Methods We developed an educational intervention bringing together interprofessional clinicians with P/F from hospital advisory councils to discuss error disclosure and prevention. Patient focus groups and orientation sessions informed curriculum and assessment design. A pre-post survey with qualitative and quantitative questions was used to assess P/F and clinician experiences and attitudes about collaborative safety education including participant hopes, fears, perceived value of learning experience and challenges. Responses to open-ended questions were coded according to principles of content analysis.
Millions of patients are accessing their medical records online via secure electronic patient portals. They are also increasingly uploading data directly into their records, and many clinicians now offer patients ready and ongoing access to the notes that document encounters. In response, patients report improved understanding of their care, better recall, enhanced adherence to care plans, and an increased sense of control over their health.
When doctors share visit notes with patients: a study of patient and doctor perceptions of documentation errors, safety opportunities and the patient–doctor relationship
Background Patient advocates and safety experts encourage adoption of transparent health records, but sceptics worry that shared notes may offend patients, erode trust or promote defensive medicine. As electronic health records disseminate, such disparate views fuel policy debates about risks and benefits of sharing visit notes with patients through portals.
Methods Presurveys and postsurvey from 99 volunteer doctors at three US sites who participated in OpenNotes and postsurveys from 4592 patients who read at least one note and submitted a survey.
Results Patients read notes to be better informed and because they were curious; about a third read them to check accuracy. In total, 7% (321) of patients reported contacting their doctor’s office about their note. Of these, 29% perceived an error, and 85% were satisfied with its resolution.
Patient and family engagement is gaining attention as a priority in patient care1 and medical education.2 OpenNotes, an innovation that invites patients to read their visit notes through a secure online portal, has demonstrated several health benefits.3 Over five million U.S. patients have online access to their notes today; shared visit notes may not only engage patients in care but also open the door to new educational innovations.
Intrigued by the idea of patient/family feedback on visit notes, our research team asked residents and their supervisors whether such feedback would be helpful.4 In surveys and focus groups, many agreed it would be.
As soon as the elevator door closed, the tears gave way, and I walked home with my head down … thoughts of my mistakes running rampant.
So began the reflection of a third-year medical student, who described falling short of his residents’ expectations on a history and physical examination. The crucial flaw? He had taken too long. His reflection continued:
[The next day], an elderly patient, traction stockings covering her small, dark brown legs, shuffled toward me. She stopped directly in front of me, her delicate, slightly stooped frame supported by her thin hand, grasping the IV pole. “Young man,” she said, “I heard you speaking to the patient in the bed next to me [last night]. And I just wanted you to know that I’m just so proud of you.… How you spoke to that patient with such care and intelligence. I’m just so proud.”
Patients, Care Partners, and Shared Access to the Patient Portal: Online Practices at an Integrated Health System
Objective To describe the characteristics and online practices of patients and “care partners” who share explicit access to a patient portal account at a large integrated health system that implemented shared access functionality in 2003.
Materials and Methods Survey of 323 patients and 389 care partners at Geisinger Health System with linked information regarding access and use of patient portal functionality.
Results Few (0.4%) registered adult patient portal users shared access to their account. Patients varied in age (range: 18–102); more than half had a high school education or less (53.6%). Patient motivations for sharing access included: to help manage care (41.9%), for emergency reasons (29.7%), lack of technology experience (18.4%), or care partner request (10.0%).
Opening Residents’ Notes to Patients: A Qualitative Study of Resident and Faculty Physician Attitudes on Open Notes Implementation in Graduate Medical Education.
OpenNotes is a growing national initiative inviting patients to read clinician progress notes (open notes) through a secure electronic portal. The goals of this study were to (1) identify resident and faculty preceptor attitudes about sharing notes with patients, and (2) assess specific educational needs, policy recommendations, and approaches to facilitate open notes implementation.