“OurNotes” asks clinicians and patients to create notes together
What is OurNotes?
OpenNotes is exploring a new way to improve communication and shared decision-making through an initiative called “OurNotes.”
OurNotes has two principal goals:
- To engage patients (and often their families) more actively in their care, and
- To help make visits more focused and efficient for both patients and clinicians
OurNotes draws on the insights of Lawrence Weed, MD, creator of the “SOAP” notes well-known to clinicians. It asks patients to compose an interval history, the “S” (subjective) component of a note, and to express their goals for a visit.
The hypotheses: OurNotes will:
- increase patient engagement
- bring more focus and structure to encounters
- promote shared decision-making, and
- off-load some work from clinicians
OurNotes draws on the “SOAP” notes well-known to clinicians and asks patients to compose an interval history, the “S” (subjective) component of a note, and to express their goals for a visit.
Patients Contributing to Their Doctors’ Notes: Insights From Expert Interviews Annals of Internal Medicine (2017)
The OurNotes process for patients
Prior to a scheduled visit, patients are asked to review their prior opennotes, and then:
- Prepare and submit a brief (300 words or less) interval history describing how things have gone since a previous visit, and
- Prepare and submit their two or three most important goals or questions for the visit
Patients send these OurNotes pre-visit forms to an electronic health record (EHR) through secure, Internet patient portals on which they have registered. The content of the forms then becomes part of their medical records, with mechanisms varying according to the local EHR system.
New System Makes it Easier for Patients to Talk to Doctors Wall Street Journal (2018)
The process for clinicians
Clinicians review the patients’ submissions prior to or during visits, and then either refer to them or incorporate them into the visit note itself.
Telemedicine and OurNotes
With the rapid adoption of telemedicine triggered by the Covid-19 pandemic, in addition to preparing their narrative histories and goals, patients are including some of the “pre-work” typically performed by medical assistants prior to face to face visits.
The OurNotes pre-visit forms ask patients to update medications they are taking and to indicate which need to be refilled. In addition, if feasible for the individual or family, patients submit their weight, temperature, blood pressure, and even their blood sugar or oxygen saturation if indicated.
OurNotes so far…
Both the patients and doctors participating in OurNotes pilot programs have offered positive reports. The practice is now spreading rapidly, both for telemedicine and in-person visits.
OurNotes Project Team
Jan Walker, RN, MBA, Co-Founder, OpenNotes, Associate Professor of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center
Tom Delbanco, MD, Co-Founder, OpenNotes, John F. Keane & Family Professor of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center
Matt Germak, MD, MPH, Director of Quality and Patient Safety for Primary Care, Beth Israel Lahey Health
Gila Kriegel, MD, Internist, Beth Israel Deaconess Medical Center, Assistant Professor of Medicine, Harvard Medical School
Sara Jackson, MD, MPH, Director, Adult Medicine Clinic, Harborview Medical Center, Associate Professor of Medicine, University of Washington School of Medicine
CT Lin, Chief Medical Information Officer, UC Health, Professor of Medicine, University of Colorado School of Medicine
Stephen Liu, MD, MPH, Internist, Dartmouth Hitchcock Medical Center, Associate Professor of Medicine, Geisel School of Medicine at Dartmouth University
Tom Payne, MD, Internist, UW Medicine, Professor of Medicine, University of Washington School of Medicine
Sigall Bell, MD, Director of Patient Safety, OpenNotes, Associate Professor of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center
Cait DesRoches, DrPH, Executive Director, OpenNotes, Associate Professor of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center
Leonor Fernandez, MD, Internist, Beth Israel Deaconess Medical Center, Assistant Professor of Medicine, Harvard Medical School
Steve O’Neill, BCD, JD, Clinical Instructor of Social Medicine, Faculty Associate, Center of Bioethics, Harvard Medical School
OurNotes Research Partner Organizations
- Beth Israel Deaconess Medical Center, Boston, MA
- Dartmouth-Hitchkock, Hanover, NH
- UC Health, Denver, CO
- University of Washington, Seattle, WA
The Commonwealth Fund
Drane Family Foundation
OpenNotes will develop OurNotes educational programs for patients, families, and clinicians. We will work with EHR vendors to incorporate OurNotes efficiently into both the patient’s and clinician’s workflow. And we plan to develop mechanisms to involve family care partners actively in OurNotes.