Shared medical notes boost patients’ engagement in their health care

‘OurNotes’ has potential to improve relationships with doctors, and cut documentation demands on clinicians.

Encouraging patients to help write and add notes to their personal medical charts — a task typically handled only by medical professionals — may help patients feel more involved with their own care and improve relationships with their doctors, a new study has found.

Enrique Rivero, Univesity of California-Los Angeles, UCLA December 01, 2017

In research published in the Annals of Internal Medicine, doctors at UCLA Health and Beth Israel Deaconess Medical Center found that patients could benefit if they are invited to co-produce medical notes, called “OurNotes,” with their doctors, rather than merely reading them. The practice may also benefit doctors by reducing time spent on documentation.

The growing OpenNotes movement allows doctors to share visit notes with patients, who may then contribute to their own medical records via OurNotes — adding material such as symptoms or medical issues they experienced since their last visit, along with goals for upcoming visits.

UCLA internal medicine specialist John Mafi, MD, led a joint UCLA/Harvard study finding that doctors believe patients could benefit if they are invited to co-produce medical notes, called “OurNotes.” Here Mafi explains the concept, from its beginnings with the OpenNotes movement on through the next steps toward potentially making OurNotes a part of physicians’ practice. UCLA Health. Youtube Dec 1, 2017

“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,” said lead author Dr. John Mafi, assistant professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA. An OurNotes pilot program will start at four centers in 2018, Mafi said.

To prepare for the pilots, researchers conducted in-depth telephone interviews with 29 health care experts. There were 11 primary care physicians, two specialist physicians, three nurse practitioners, four health information technology professionals, eight patient advocates and one policy expert. All were familiar with OpenNotes or were OpenNotes users.

Participants overall believed that OurNotes could promote patient engagement, improve patient-centered care and patient-provider collaboration, and possibly take some of the documentation burden off busy providers. The consensus was that the most promising approach for OurNotes is to contact patients before an upcoming visit and ask them to review previous notes, provide an interval history, and list what they hope to address at the visit.

Participants were clear that patient contributions should not increase providers’ workloads or disrupt workflow, and that participation in OurNotes should not be a requirement, but offered as an option.

“One can argue that reading a note is far less active than actually participating in producing a note. Transforming practice with OurNotes holds great promise for more active patient involvement,” said senior author Jan Walker, OpenNotes co-founder and assistant professor of medicine at Harvard Medical School. “We’ve had a warm reception from clinicians who want to give OurNotes a try. 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.”

OurNotes will start at four sites: Beth Israel Deaconess Medical Center, University of Washington, Dartmouth-Hitchcock Medical Center and University of Colorado. The pilot interventions will focus on patients who may benefit the most: those managing the challenges that accompany chronic illness.

Funding for OurNotes is provided by the Commonwealth Fund of New York. Study co-authors are Macda Gerard, Hanna Chimowitz, Melissa Anselmo and Dr. Tom Delbanco of Beth Israel Deaconess Medical Center and Harvard Medical School.

Source  University of California, UCLA via Science Daily

References

Patients Contributing to Their Doctors’ Notes: Insights From Expert Interviews, Mafi JN, Gerard M, Chimowitz H, Anselmo M, Delbanco T, Walker J. Ann Intern Med. 2017 Nov 14. doi: 10.7326/M17-0583. [Epub ahead of print]

A Theoretical Twist on the Transparency of Open Notes: Qualitative Analysis of Health Care Professionals’ Free-Text Answers, Erlingsdóttir G, Petersson L, Jonnergård K. J Med Internet Res 2019;21(9):e14347 DOI: 10.2196/14347 PDF

Qualitative and Quantitative Analysis of Patients’ Perceptions of the Patient Portal Experience with OpenNotes, Mishra VK, Hoyt RE, Wolver SE, Yoshihashi A, Banas C. Appl Clin Inform. 2019 Jan;10(1):10-18. doi: 10.1055/s-0038-1676588. Epub 2019 Jan 2.

OpenNotes After 7 Years: Patient Experiences With Ongoing Access to Their Clinicians’ Outpatient Visit Notes, Walker J, Leveille S, Bell S, Chimowitz H, Dong Z, Elmore JG, Fernandez L, Fossa A, Gerard M, Fitzgerald P, Harcourt K, Jackson S, Payne TH, Perez J, Shucard H, Stametz R, DesRoches C, Delbanco T. J Med Internet Res. 2019 May 6;21(5):e13876. doi: 10.2196/13876 Full text

Evaluating the impact of patients’ online access to doctors’ visit notes: designing and executing the OpenNotes project, Leveille SG, Walker J, Ralston JD, Ross SE, Elmore JG, Delbanco T. BMC Med Inform Decis Mak. 2012 Apr 13;12:32. doi: 10.1186/1472-6947-12-32. Full text

A New Chapter in Patient-Centered Care: Sharing the Medical Note? Safford MM. Ann Intern Med. 2017 Nov 14. doi: 10.7326/M17-2802. [Epub ahead of print]

Inviting Patients to Read Their Doctors’ Notes: Patients and Doctors Look Ahead, Jan Walker RN MBA, Suzanne G. Leveille PhD RN, Long Ngo PhD, Elisabeth Vodicka BA, Jonathan D Darer MD MPH, Shireesha Dhanireddy MD, Joann G Elmore MD MPH, Henry J Feldmanm MD, Marc J Lichtenfeld PhD, Natalia Oster MPH, James D. Ralston MD MPH, Stephen E Ross MD, and Tom Delbanco MD. Ann Intern Med. 2011 Dec 20; 155(12): 811–819. doi: 10.7326/0003-4819-155-12-201112200-00003

Impact of an Electronic Health Record-Integrated Personal Health Record on Patient Participation in Health Care: Development and Randomized Controlled Trial of MyHealthKeeper, Ryu B, Kim N, Heo E, Yoo S, Lee K, Hwang H, Kim JW, Kim Y, Lee J, Jung SY. J Med Internet Res 2017;19(12):e401 DOI: 10.2196/jmir.8867 Full text

Also see
The Next Step for OpenNotes Is OurNotes OpenNotes
From OpenNotes to OurNotes: New project heads toward *real* participatory medicine OpenNotes