How will this module help me successfully adopt OpenNotes?
Outlines six steps for increasing transparency by adopting OpenNotes
Presents evidence to support the case for using OpenNotes in your practice
Shares resources to help you learn how to write transparently and help clinicians, patients and caregivers make the most of shared notes
Provides case studies and examples from early adopters of OpenNotes
Allowing patients to access information in their medical records can improve the relationship between physicians and their patients. While most practices agree with this viewpoint, they often struggle with how to go about increasing transparency. OpenNotes is an approach that many practices have used successfully to do just that.
Quiz Ref IDOpenNotes is a national initiative working to give patients easy access to their health care visit notes. OpenNotes is not a software package or product, but rather a simple change in how your practice uses its patient portal that's been shown to promote patient engagement and enhance the patient-physician relationship.
The initiative began in 2010 when over 100 primary care physicians across three large medical institutions began sharing notes with their patients. Today, over 70 health systems have adopted OpenNotes and more than 12 million patients can access their notes online. This free process works through existing electronic health record (EHR) and patient portal platforms.
Patients, administrators and everyone on the care team has a role in making patient access to their clinician notes a routine part of health care. This module will outline how the concept of sharing visit notes with your patients can be achieved through OpenNotes. Step-by-step strategies are outlined to guide you in adopting OpenNotes, as well as tips for physicians and the entire care team to maximize the benefits of OpenNotes.
The value of increasing patient access to their clinic notes through OpenNotes
A study published in the Annals of Internal Medicine looking at the effect on physicians and patients of facilitating patient access to visit notes through OpenNotes2 found that:
More than 90 percent of physicians reported that they did not need more time to address patients' questions outside of visits.
Approximately 80 percent of physicians reported taking the same amount or less time to write notes.
Approximately 90 percent of patients opened their notes made available through OpenNotes.
Two-thirds of patients reported doing better with taking medications as prescribed because of OpenNotes.
More than 75 percent of patients reported that OpenNotes helped them feel more in control of their care.
Nearly 90 percent of patients agreed that the availability of OpenNotes would be an important factor in choosing a future doctor or health plan.
Ninety-nine percent of patients and more than three-quarters of physicians wanted OpenNotes to continue.
Six STEPS to increasing patient access to clinical notes through OpenNotes
Educate your practice about clinical note transparency and OpenNotes
Plan what OpenNotes will look like in your practice
Prepare your practice and patients
Adapt your documentation style as needed
Learn to handle challenging topics in an OpenNotes environment
Collect patient and clinician feedback about OpenNotes to refine your approach
STEP 1 Educate your practice about clinical note transparency and OpenNotes
Describe and share research on the many potential benefits to both patients and physicians of giving patients access to their visit notes. In particular, share research that has shown that patients who have access to their visit notes report that they:
Feel more in control of their health care
Have a better understanding of their medical conditions
Are more likely to adhere to their medications
Quiz Ref IDThe research also showed that physicians and other clinicians who shared their notes saw:
Improvements in patient satisfaction, safety, communication and education
Improvements in the patient-physician relationship, including enhanced trust, transparency, communication and shared decision making
Patients better prepared for their clinic visits and becoming more actively involved in their care
Communicate the benefits of OpenNotes to relevant stakeholders in your organization such as practice leadership, your colleagues, staff and patient advocacy groups and/or patient family and advisory councils.
STEP 2 Plan what OpenNotes will look like in your practice
Quiz Ref IDWhen implementing OpenNotes, it is important to take into account policy considerations that your practice or organization may have. Issues such as which clinicians or departments will share notes, how to introduce patients to OpenNotes, how proxies will access patient notes and how patient requests to change notes will be handled all need to be addressed prior to rollout. Other considerations include whether individual notes can be hidden by clinicians and whether any notes will be shared retroactively. Outline team member responsibilities regarding OpenNotes, such as who will educate patients on registering for the patient portal and how to find their notes within the portal. For those who have an EHR, it is important to work with your vendor to identify any IT needs for implementation, roll out and optimization of the interface for patients and caregivers.
STEP 3 Prepare your practice and patients
As with anything new, you may encounter some initial resistance internally when adopting OpenNotes. Prepare your practice and potentially decrease pushback by raising awareness. Discuss the importance of transparency and answer questions about OpenNotes in team meetings, educate team members and patients on the benefits of OpenNotes, and encourage practice-wide participation in implementing the new approach. There are also many opportunities to network and learn about best practices from other organizations and physicians who have already implemented OpenNotes. For example, clinicians at the Mayo Clinic have been sharing all visit notes with patients since 2013.
The more you can prepare everyone involved about the adoption of OpenNotes, the easier the transition will be. Help prepare your patients, team members and all stakeholders by raising awareness. The following are some suggestions for doing so.
To prepare clinicians and practice staff:
Describe and share research on the many potential benefits during team meetings.
Distribute clinician-specific FAQs.
Provide department leaders and/or your organization's CEO with a template email they can send to staff.
Post information about adopting OpenNotes on your practice or organization staff intranet site.
To prepare patients and caregivers:
Send an email introducing OpenNotes and how it will impact them.
Make patient-specific FAQs available in all waiting rooms, in exam rooms, on your patient portal and wherever else your patients may easily access them.
Post information about adopting OpenNotes on your practice or organization website and patient portal.
Promote the adoption of OpenNotes through your practices' and/or organizations' marketing channels such as a practice newsletter, or on Facebook and Twitter.
As your practice gains more experience with OpenNotes, help spread the word and continue to engage your stakeholders by:
Collecting stories from patients and clinicians in your practice who are using OpenNotes and share them through your practices' and/or organizations' marketing channels such as a practice newsletter, or your website.
Asking patients and clinicians to blog about their experiences with OpenNotes.
Committing to track OpenNotes utilization by both patients and clinicians so you can regularly update stakeholders with the findings.
Adding questions about OpenNotes to your patient satisfaction survey.
STEP 4 Adapt your documentation style as needed
Just because patients will now be able to view the note, that doesn't mean that you or your team need to make dramatic changes to your writing style. In fact, most physicians won't need to make any changes to their speaking or writing style. Convey the need for mindfulness when communicating with patients (either verbal or in written communications) to medical assistants, nurses and anyone else on the team who contributes to team documentation. General communication strategies include:
Speaking or writing only about things discussed with the patient during that visit
Not including commentary that could be interpreted as labeling or judgmental
Being positive and supportive
Avoiding use of medical jargon, acronyms and abbreviations. Not only does this create confusion, but some terms may unintentionally offend patients if they don't know what it means. For example, SOB is commonly used as an abbreviation for shortness of breath that could be misinterpreted as a derogatory remark
STEP 5 Learn to handle challenging topics in an OpenNotes environment
Long before the OpenNotes initiative, clinicians worried about how to document challenging topics such as mental health, obesity, substance use, physical abuse, driving privileges, visits with potentially litigious patients or suspicions of life-threatening illness. Sensitive issues clearly require special attention.
Although it is natural to want to curb or avoid some challenging conversations, patients may benefit from direct dialogue. For example, when a clinician notices signs of dementia, depression or impaired driving, chances are that the patient or family members are already worrying about these issues as well. They may find that a balanced discussion helps alleviate their anxiety.
STEP 6 Collect patient and clinician feedback about OpenNotes to refine your approach
To fully understand the impact OpenNotes is having on your practice, measure the process from start to finish—establish a baseline, a midpoint and an endpoint for your OpenNotes initiative. You can collect information on the use of and perspectives about OpenNotes through informal hallway conversations, at team meetings and by adding questions about OpenNotes to your patient satisfaction survey. Another option is to track the volume of patient emails and phone calls before and after OpenNotes as an indirect measure of the effect of OpenNotes on time spent by clinicians fielding patient questions. Work with your EHR vendor or IT team to quantify how many patients view their notes via the patient portal.
Other physicians who are experienced with OpenNotes are excited by finding new ways in which their patients can obtain their health information easily. They encourage patients to register for the patient portal, describing it as an extension of their practice. These physicians also encourage their patients to ask questions through email and text.
OpenNotes is a method to engage patients and increase transparency by sharing clinician notes with patients. Quiz Ref IDSharing notes can empower patients to be more active participants in their care, making them more likely to follow through on treatment recommendations. OpenNotes usually does not require additional clinician time or effort during a visit to have a positive impact on a practice and its patients.
Although studies are underway nationally, there is still much to learn about eliciting and responding to patient preferences and understanding how documentation affects desired health outcomes. In the meantime, sharing stories about OpenNotes (good and bad) in appropriate settings, and incorporating such experiences in case discussions, conferences and team meetings will bolster the collective wisdom and skill in writing transparent notes over time. You may find it helpful to regroup as a team after completing this module to share your experience.