OpenNotes Initiative Boosts Patient Engagement, Safety
Giving patients access to doctors' notes in electronic health records can increase engagement, safety and care quality, according to a study published in the Joint Commission Journal on Quality and Patient Safety, FierceHealthIT reports (Hall, FierceHealthIT, 8/13).
Background on OpenNotes
A pilot project to test OpenNotes was launched in 2010 and funded through a $1.4 million grant from the Robert Wood Johnson Foundation Pioneer Portfolio. It involved about 100 primary care physicians and 25,000 patients at:
- Beth Israel Deaconess Medical Center in Massachusetts;
- Geisinger Health System in Pennsylvania; and
- Harborview Medical Center in Washington state.
At the end of the pilot program, 99% of participants said they wanted continued access to physician notes, regardless of initial privacy concerns (iHealthBeat, 4/10/14).
Department of Veterans Affairs hospitals began to offer OpenNotes in 2013, and nine health organizations in Oregon and Washington used the tool beginning last year (FierceHealthIT, 8/13). Since its launch, the initiative has grown to reach 5 million users nationwide (BIDMC release, 8/13)
For the study, researchers affiliated with BIDMC analyzed five years' of survey data on the use of OpenNotes to determine issues related to patient safety and quality of care (FierceHealthIT, 8/13).
According to the study, patients said having access to their doctors' notes helped them to:
- Notice errors in their records;
- Recall more of what happened during office visits;
- Remember to follow up on important appointments; and
- Remember to take their medication.
Meanwhile, doctors said the OpenNotes system had little to no effect on their workflow.
However, doctors expressed some concerns, including:
- How patients would define mistakes;
- How patients would report errors (BIDMC release, 8/13);
- How the process would affect patient-provider trust; and
- Whether their notes would become vague knowing that patients would be reading them (FierceHealthIT, 8/13).
Overall, lead author Sigall Bell -- an assistant professor at Harvard Medical School -- said patients and doctors said OpenNotes helped them:
- Improve coordination of care;
- Improve error reporting;
- Improve plan adherence;
- Reduce diagnostic delay;
- Remember next steps; and
- Spot medication errors.
The researchers are using the preliminary findings to guide a two-year study called the OpenNotes Patient Safety Initiative. The study, funded by hospital insurance provider CRICO, will look at how sharing doctors' notes with patients affects:
- Medical errors; and
- Patient safety.
Researchers also have implemented a pilot program using an OpenNotes prototype with a group of volunteer clinicians at HealthCare Associates, BIDMC's primary care practice. Recently, CRICO provided funding for more widespread access to OpenNotes at BIDMC and Boston Children's Hospital (BIDMC release, 8/13).
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