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OpenNotes, Patient Feedback Tools Improve Patient Safety

Patients who have access to their health data and can provide feedback on it may help prevent negative patient safety events, OpenNotes finds.

By Sara Heath

A new study from OpenNotes shows that offering patients a method to engage with physician notes and offer feedback on what they see can help improve care outcomes and patient safety.

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The researchers introduced a feedback tool to 41 physicians who had already adopted the OpenNotes philosophy. Through this outreach, 6225 patients used the tool over the test period from August 2014 to August 2015.

Overall, 44 percent of participating patients looked at their notes, and one in 12 (about 8 percent) of patients used the feedback function, according to a report published in BMJ Quality and Safety.

The feedback tool proved effective for citing inaccuracies, which may help to avoid negative patient safety events. Of the patients who used the feedback function, 23 percent reported safety concerns, usually pertaining to medication errors or misreporting of pre-existing health conditions.

Sixty-four percent of feedback reports were categorized as confirmed or possible concerns. Eventually, 57 percent of the reports resulted in actual changes to the medical record.

OpenNotes and the feedback tool also improved patient safety through better education. The researchers found that 96 percent of patients who used the feedback tool had adequate understanding of what the note actually said, helping them to stay accountable for and engaged in their own care.

“Our findings add to a growing literature suggesting that patients can help identify mistakes,” said lead author Sigall Bell, MD. “We were struck that nearly all patients and care partners in the study found the feedback tool valuable. What that indicates to us is that patients are eager to help their health care teams ‘get it right.’”

The feedback tool not only improved patient experience through increased patient safety and understanding; the results show that most of the patients were satisfied with the tool, as well. Ninety-nine percent of patients and caregivers found the feedback tool valuable, and 97 percent said they wanted to continue with the tool after the study concluded.

Physicians were likewise impressed with the tool, the researchers said.

Prior to the study, participating physicians expressed worry that the feedback tool would cause the patient-provider relationship to deteriorate. However, over the course of the study, no participants reported patient-provider relationship issues, and none reported any workflow issues.

“We were pleased to find that the OpenNotes reporting tool helped to identify quality improvement opportunities without appearing to add to clinician burden,” said Bell, who is also OpenNotes Director of Patient Safety and Discover and an associate professor of medicine at Harvard Medical School.

“We believe that if patients know their feedback is welcome and encouraged, the potential to reduce errors or clear up confusion about the care plan will be even greater.”

This research builds on what OpenNotes found in its 2011 study published in the Annals of Internal Medicine – that providing patients with access to physician notes can improve patient engagement and satisfaction.

A majority of patients – 12,000 of the nearly 13,500 participants – looked at their physician notes over the course of the study. About 60 percent of patients on drug treatments reported better medication adherence as a result of physician note access and 80 percent reported better control over their healthcare.

Due to this success, OpenNotes flourished, receiving a $450,000 grant from the Commonwealth Fund and other benefactors to scale their approach.

From there, OpenNotes has expanded across the country. In April, 2016, Mount Sinai Health System adopted the OpenNotes philosophy, expanding access to physician notes to all of its patients.

By August, 2016, OpenNotes had reached ten million patients. According to an organization statement, OpenNotes had reached this number of participants from just 20,000 four years prior.

“Just four years later, we’re seeing the culture shift toward transparency in the patient and provider relationship really take hold, and we’re beginning to understand the benefits that openness brings to everyone in the health care delivery system,” said OpenNotes Executive Director Cait DesRoches, DrPH.

These latest results demonstrate the potential for OpenNotes, and patient engagement in general, to improve care outcomes. By giving patients access to their health data and the ability to hold their providers accountable, they can make sure they receive the correct treatments for their current ailments.

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