ORLANDO -- The program that encourages providers to share their visit notes with patients is continuing to pick up steam, , said here at the annual meeting of the Healthcare Information and Management Systems Society (HIMSS).
Despite physicians' initial apprehension at sharing their notes, "the most common provider response was 'this was a non-event,'" said Chin, who is with Oregon Health & Science University, in Portland and an associate with OpenNotes, during a .
The OpenNotes effort began in 2010 as a demonstration project; it involved more than 100 primary care doctors and 20,000 patients in Boston, rural Pennsylvania, and Seattle, he explained. The effort is funded with money from the Robert Wood Johnson Foundation, the Peterson Center on Healthcare, Cambia Health, and other foundations. "One of the key things is we're not a specific vendor product," said Chin, noting that most of the major electronic health record vendors can arrange for patients to view the notes securely through a patient portal.
Another advantage of the OpenNotes effort is that "we're not selling anything; we're really an advocacy organization," he continued. "We're not in this for the money ... Our goal is to reach 50 million patients with access to their provider's notes within the next 2 years; we're up to 12 million, so we are well on the way."
Physicians who are asked to implement OpenNotes are often apprehensive about a few things, but their apprehensions largely go away once the program has been implemented, Chin noted. For example, one survey found that:
- Before OpenNotes started, 24% of respondents feared it would make visits significantly longer; only 2% said afterward that this was an issue
- Before OpenNotes, 42% expressed concern that they would need to spend more time addressing patients' questions and problems; only 3% found that to actually be a problem
- Before OpenNotes, 39% of respondents said they were worried that they would spend more time writing, editing, and dictating notes; only 11% said that turned out to be an issue
Although 11% of physicians did say they were spending more time writing, editing, and dictating notes, "we're finding they're changing the way they're writing notes a little bit, but it's more that they're watching for certain terms and writing them a different way, not necessarily taking more time," Chin said. "If anything, their notes are a little more clear, even for other physicians."
On the other hand, patients were also surveyed about their perceptions and reported several benefits from the program:
- 70%-72% said they were "taking better care of themselves"
- 77%-85% said they had "better understanding of their medical conditions"
- 69%-80% said they felt "better prepared for visits"
- 60%-78% said they were "doing better with taking my medications as prescribed"
In addition, Chin said, "85% of patients said that the availability of OpenNotes would affect their future choice of providers," and almost 100% of both doctors and patients wanted to continue with the program. OpenNotes may also help to decrease litigation by providing better communication with patients, although that is still under investigation, he said.
For healthcare facilities wanting to implement the program, "clinician leadership is really key," Chin said. The program recommends starting with a pilot project for a very short period of time, to introduce the idea.
"Encourage people not to allow individual providers to opt out on their own; do it as an organizational effort," he said. Of course, there are certain circumstances where a note may contain sensitive information, such as notes involving mental health problems, or domestic violence, "so it's okay to have a mechanism to not share a note," such as a button that the provider can click.
Geisinger Health System has had a very good experience with OpenNotes, according to , the organization's senior vice-president and chief information officer, in Danville, Pa. "There was pushback initially, but over the next few years we really got full adoption."
Within the Geisinger system, everyone with an EHR has access to a patient portal, and about 650,000-700,000 patients are engaged in it. Of those, 300,000 are really active; the system gets about 90,000 logins per month, said Kravitz.
Currently there are about 2,600 Geisinger providers participating in OpenNotes; the system doesn't include mental health or substance abuse treatment providers, or emergency department clinicians, although that may change, he said.
As for the program's overall effect, "it isn't taking us much longer, if at all -- in fact, it's shortening our appointment time," he said. Initially, some providers "felt like they were opening themselves up to a lot of questions from patients, but after they got over their initial [apprehension], it's been very well received by the provider staff." In addition, "we are seeing better medication adherence, especially with hypertension medication."
Recent additions to Geisinger's OpenNotes program include the use of iPads in the inpatient setting, as well as the outfitting of inpatients' televisions with Apple TV so patients can review notes with MyChart Bedside. "It's been very beneficial."
Geisinger has also started another initiative called OurNotes, which gets patients more involved. "It gives the patient the opportunity to set agendas for appointments with their provider, and bring up things they might otherwise forget about," said Kravitz. "It has been really helpful."
During a question-and-answer session, Chin noted that OpenNotes has been beneficial to patients regardless of their education or income level: "The interesting thing is that folks who are homeless or underserved -- most of them have smartphones" so they can still see the information, he said. "If English is a problem ... most folks where English is not their first language will have someone in the family who will be able to read it and help them through. And we are working with federally qualified health clinics to get more on board."