- Many across the healthcare industry are familiar with OpenNotes, the nationwide movement to grant patient data access to view clinician notes. Now, the researchers behind OpenNotes have developed OurNotes, a similar philosophy that also allows patients to add to their provider notes.
This first study into OurNotes included interviews with healthcare providers across the country in preparation for a pilot launch. Interviewees included 11 primary care providers, two specialists, three nurse practitioners, four health information technology experts, eight patient advocates, and one healthcare policy expert.
All of the interviewees had adopted or at least heard of OpenNotes.
Respondents largely agreed that OurNotes, which allows patients to participate in the creation of medical record notes, could enhance patient engagement. OpenNotes has already upped the patient engagement game, but asking patients to actively participate in creating those notes has the potential to bring patient engagement to the next level.
Interviewees stated that OurNotes could lead to more patient-provider communication, shared decision-making, and patient-centered care. The crux of the approach is asking patients to actively participate in and engage with their clinician notes, according to OpenNotes co-founder Jan Walker, RN, MBA.
“One can argue that reading a note is far less active than actually participating in producing a note,” said Walker, who is also an assistant professor of medicine at Harvard Medical School. “Transforming practice with OurNotes holds great promise for more active patient involvement.”
“We’ve had a warm reception from clinicians who want to give OurNotes a try,” Walker added. “They are intrigued by the notion that an interval history and agenda provided by a patient is a way to streamline the visit and address the patient’s priorities more effectively.”
Additionally, the strategy could help alleviate some of the administrative burden currently bogging down clinician workflows, said lead author John Mafi, MD, MPH.
“If executed thoughtfully, OurNotes has the potential to reduce documentation demands on clinicians, while having both the patient and clinician focusing on what’s most important to the patient,” noted Mafi, who is also an assistant professor of general medicine and health services research at the UCLA David Geffen School of Medicine.
Respondents recommended users first approach patient participation with OurNotes by asking patients to review and revise medical records prior to appointments. Additionally, patients should record what they hope to accomplish during their visit.
Respondents also added that OurNotes participation should be entirely voluntary.
OurNotes rollout is set to begin in 2018 at four different care sites, the program developers said. Beth Israel Deaconess Medical Center, University of Washington, Dartmouth-Hitchcock Medical Center, and University of Colorado will all pilot OurNotes.
Pilots will focus on patients managing chronic illness.
Program leaders at OpenNotes have already launched a similar tool that yielded positive results. A 2016 study published in BMJ Quality and Safety found that patients with annotation capabilities alongside OpenNotes clinician note access were able to improve the accuracy of their medical records.
OpenNotes extended access to the annotation tool to 41 OpenNotes users, reaching over 6,000 patients over the one-year test period.
Forty-four percent of participating patients looked at their provider notes, and about 8 percent used the feedback tool. Of the patients who used the feedback tool, 23 percent reported safety concerns, usually pertaining to medical errors or misreporting of pre-existing health conditions.
Sixty-four percent of flags were categorized as confirmed or possible concerns, and 57 percent of those resulted in actual medical record changes.
In addition to these patient safety improvements, the annotation tool also revealed that clinician note access improved patient engagement with care. Ninety-six percent of patients who used the annotation tool understood their clinician notes completely, helping patients to stay accountable for and engaged with their own healthcare.
Ideally, the OurNotes philosophy will have the same impact. By allowing patients to actively read and interact with their clinician notes, the project can help improve patient engagement rates across the country.