EHR and Patient Portal Toolkit
Which EHR companies have OpenNotes functionality?
As EHR companies update their products to meet regulatory standards and the evolving needs of clinicians, insurers, and patients, many are making it easier to share visit notes with patients. Here are the companies we know support OpenNotes functionality.
- Allscripts (coming soon)
- Cerner (coming soon)
- eClinicalWorks (coming soon)
- Epic (coming soon)
Help Patients Find Their Notes
We regularly hear from patients that the EHR and patient portal user experience can be challenging, and they often give up before finding what they need. Our communications toolkit includes examples of materials created by health systems to improve the user experience. As a growing number of people report using their cell phones as the primary method for communication and digital access, we recommend that these materials be used to optimize for the mobile experience as well.
These functions should be considered to give health systems and clinicians the flexibility they need to successfully implement OpenNotes and optimize patient engagement.
- Opt-in and Opt-out
The ability to configure the software to opt-in or opt-out individual providers, departments, clinic locations, provider-types, and encounter types, gives health systems the ability to accommodate pilot testing and various approaches to implementation.
- Sensitive Information
Providing the option to hide a note by clicking a “do note share” check-box or having a designated encounter type that is not sent to the portal, allows clinicians to document patient-sensitive information that is not shared with the patient.
“This gives clinicians reassurance that there is a mechanism to chart information that they do not wish to share with the patient. Our experience is that over time, less than 0.1% of encounters have information that is hidden from the patient in this way.”— Homer Chin, MD, OpenNotes Electronic Health Record Expert
- Discharge Summaries
Providing functionality to release the entire patient discharge summary improves continuity of care at an important transition time. Even if the physical paper is misplaced, clinicians, patients, and caregivers will be able to rely on online access to understand the patient’s recent medical course, post-discharge instructions, and plan of care.
- Patient Educational Materials
Providing promotional and educational materials including posters, handouts, videos, and email messages helps patients adjust to the change of practice and can lead to increased portal adoption, page views, and patient engagement.
- Patient Reminders
Incorporating the ability for health systems to send automatic email reminders to patients significantly increases the likelihood that the notes will be read and used by patients. It may also be helpful to highlight unread items to remind patients about notes they have not yet reviewed.
“We let hospital leadership know that receiving email reminders when notes are ready to read was essential for us as patients.”— Margery Rosenblatt, University of Vermont PFAC
- Proxy Access
Providing the ability for patients to grant access to caregivers, family, or designated friends helps these care partners gain a good understanding of a patient’s medical situation and aids in their ability to care for the patient.
Building in the functionality to identify and report errors in the medical record helps streamline the process patients use to request corrections to the chart as well as the process health systems use to address patient concerns, leading to improved patient safety and decreases in the risk for medical errors.
“Even adding a simple sentence at the bottom of a note directing patients what to do if they see an error or inaccuracy is a powerful way to engage them in the safety of their own care.”— Sigall Bell, MD, OpenNotes Director of Patient Safety and Discovery
- Monitoring Portal Utilization
The capability to monitor metrics such as percent of patients with portal access, how often the portal is accessed, percentage of patients reading their provider notes, numbers of requests for corrections, etc., allows health systems to assess the effectiveness of their approach to providing access to notes.
Additional Functionality to Consider
These functions support enhanced bi-directional communication between patients and clinicians.
- Patient Contribution
Providing the capability for patients to contribute to their medical record has the potential to improve communication between patients and clinicians. Several organizations are piloting an initiative called OurNotes, which invites patients to coproduce visit notes with their clinicians. An initial study shows potential for significant improvements in both the patient and clinician experience with care delivery.
- Notes in the Inpatient Setting
Releasing other inpatient information (consults, progress notes, labs, radiology and pathology reports) right away, or after a delay of two to four days, or upon discharge helps patients and their caregivers manage care after a hospital stay.
- Patient Preferences
Giving patients the ability to change settings affecting the frequency of reminders or to set up information filters for proxies, etc., helps the patient manage the flow of information and may improve patient satisfaction.
- Provider Ability to See When Notes Have Been Read
The option of having the note in the EHR change color, or to be marked in some other way, allows the provider to see which notes the patient has read.
- Reference Links
The ability to provide links from items in the record (medications, diagnoses, lab names) to reference information that will explain those items allows patients to get important information with a single click and ensures that they are going to trusted sites for medical information..
- Order Status and Results
Creating functionality that shows outstanding orders, referrals, or tests streamlines processes. It also makes it easier for patients to follow through on the care plan.