“OurNotes” asks clinicians, patients, and care partners to create notes together
What is OurNotes?
OpenNotes has been exploring a new way to improve communication and shared decision-making through a research initiative called “OurNotes.”
OurNotes has two principal goals:
- To engage patients more actively in their care, and
- To help make visits more focused and efficient for patients, care partners, 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 express their goals for a visit..—Tom Delbanco, MD, MACP
Related publications
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 open notes, and then to:
- 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 2 or 3 most important goals or questions for the visit
Patients send the 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.
Related articles
New System Makes it Easier for Patients to Talk to Doctors Wall Street Journal (2018)
The OurNotes 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.
Related publications
Covid-19 as Innovation Accelerator: Cogenerating Telemedicine Visit Notes with Patients NEJM Catalyst (2020)
OurNotes process for care partners
In OurNotes for Care Partners, a patient’s identified care partner is asked to complete the “Caregiver Intensity Index” before and after a medical visit, and report their score using OurNotes.
OurNotes so far…
The patients and doctors participating in OurNotes pilot programs have offered positive reports, and the practice is now spreading rapidly, both for telemedicine and in-person visits.
OurNotes project team
Principal Investigators
Jan Walker, RN, MBA, Co-Founder, 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*
Co-Investigators
Tom Delbanco, MD, MACP, Co-Founder, OpenNotes, John F. Keane & Family Professor of Medicine, Harvard Medical School and Beth Israel Deaconess Medical Center*
Joe Dong, MS, Biostatistician, OpenNotes, Beth Israel Deaconess Medical Center*
Alex Drane, CEO, ARCHANGELS*
Matt Germak, MD, MPH, Chief Quality and Safety Officer, Beth Israel Lahey Health Primary Care
Sara Jackson, MD, MPH, Director, Adult Medicine Clinic, Harborview Medical Center, Associate Professor of Medicine, University of Washington School of Medicine
Gila Kriegel, MD, Internist, Beth Israel Deaconess Medical Center, Assistant Professor of Medicine, Harvard Medical School
Suzanne Leveille, RN, PhD, Professor, University of Massachusetts
CT Lin, MD, 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, Dartmouth Geisel School of Medicine
Steve O’Neill, BCD, JD, Clinical Instructor of Social Medicine, Faculty Associate, Center of Bioethics, Harvard Medical School
Tom Payne, MD, Internist, UW Medicine, Professor of Medicine, University of Washington School of Medicine
Hannah Shucard, MS, Research Coordinator, University of Washington School of Medicine
Sarah Stephens Winnay, Co-Founder, ARCHANGELS*
Jennifer L. Wolff, PhD, Director, Roger C. Lipitz Center for Integrated Health Care, Johns Hopkins Bloomberg School of Public Health*
*This investigator also collaborates on OurNotes for Care Partners.
OurNotes project contact
OurNotes for Care Partners project contact
OurNotes and OurNotes for Care Partners research partner organizations
- ARCHANGELS
- Beth Israel Deaconess Medical Center, Boston, MA
- Beth Israel Lahey Health Primary Care, Boston, MA
- Catholic Health in Buffalo, NY
- Dartmouth-Hitchcock, Hanover, NH
- Michigan Medicine
- UC Health, Denver, CO
- University of Washington, Seattle, WA
Related articles
BIDMC Receives Commonwealth Fund Grant to Develop OurNotes (2015)