Healthcare Transformation Learning Session July 23rd Webinar, 1:00 - 2:00 PM Learning Topic: Open Notes - inviting patients to review their visit notes written by their doctors, nurses, or other clinicians. Featured speakers: • Jan Walker, RN, MBA, Co-Director, Open Notes, Assistant Professor of Medicine, Harvard Medical School • Melissa Anselmo, MPH, National Program Director, Open Notes Regional Update: Krista Stock, Director, Healthcare Collaborative of Greater Columbus Lead Support
Major Support
Additional Support 100% of our Board of Directors & Staff Individual & Corporate Donations
www.hcgc.org
Open Notes: Toward a New Standard of Care Jan Walker, RN, MBA
Co-Director, Open Notes Assistant Professor of Medicine, Harvard Medical School
Melissa Anselmo, MPH
National Program Director, Open Notes Beth Israel Deaconess Medical Center Boston, MA
Agenda 1. The case for open notes 2. Approaches to implementation 3. Future directions
4. Q&A
What are open notes? Open notes are visit notes that patients can access online through patient Internet portals.
www.MyOpenNotes.org
About the OpenNotes Study 1-year Demonstration Project summer 2010 – summer 2011 (and still ongoing) Patients invited to view their PCPs’ signed notes via secure portals (only notes signed during the project – not retroactive) Each patient notified automatically via secure e-mail message when a note was signed, and later reminded to review note(s) before next visit Patients and doctors completed surveys before and after, and we collected administrative data (portal clicks, e-mail volume) Primarily funded by the Robert Wood Johnson Foundation
Three Principal Questions Would OpenNotes help patients become more engaged in their care?
Would OpenNotes be the straw that breaks the doctor’s back?
After 1 year, would patients and doctors want to continue?
Diverse Sites 108 volunteer PCPs and more than 19,000 of their patients who use portals: •
BIDMC (urban and suburban Boston) • 39 PCPs & 10,300 patients
•
Geisinger Health System (rural Pennsylvania) • 24 PCPs & 8,700 patients
•
Harborview Medical Center (inner city Seattle) • 45 PCPs & 270 patients (new portal)
Patients’ Experience
Among Patients with Notes (Visits) 82% of patients opened at least one of their notes Including patients who were older, sicker, less educated Few patients said reading notes made them feel Worried (5-8%) Confused (2-8%) Offended (1-2%) 20-42% of patients reported sharing notes with others 60% wanted to comment on their notes
Reports from Patients About 3 out of 4 patients reported: taking better care of themselves
understanding their health and medical conditions better feeling more in control of their care feeling better prepared for visits
doing better with taking their medications as prescribed
The Bottom Line for Patients
After one year, 99% of patients wanted to continue to be able to see their visit notes online..
When given a choice of doctors or health plans in the future: 4 out of 5 patients said availability of open notes would impact their choice of provider.
PCPs’ Concerns and Experiences
PCPs’ Main Concerns
OpenNotes Impact on Workflow Pre-intervention (%)
Post-intervention (%)
More time addressing patient questions outside of visits
42
3
More time writing/editing notes
39
11
 Email message volume did not change
The Bottom Line for PCPs After a year, PCPs were asked: Taking all considerations into account, I would like my patients to continue to be able to see my visit notes online. At least 3 out of 4 said YES
Even though some said NO: At the trial’s end, not one doctor asked to turn it off for their patients.
15
The Bottom Line for the Three Institutions All 3 sites decided to expand OpenNotes Geisinger : 1,400 ambulatory
doctors/NPs/PAs, and 200,000 patients
Harborview: launching as Epic is rolled out, will expand to all UW primary and specialty clinics in 2014
BIDMC: All clinicians’notes
Vast majority of ambulatory clinicians
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Guest and Quincy. Consumers Gaining Ground in Health Care, JAMA, 2013
Walker, Darer, Elmore, and Delbanco. The Road toward Fully Transparent Medical Records, N Engl J Med, 2014
Join the OpenNotes Movement Letting Patients Read Doctors’ Notes
Ten Ways Patients Get Treated Better
Will Reading Your Doctor’s Notes Lead to Better Health?
Boston hospital pilot gives patients electronic access to their therapists’ notes
The Road Toward Fully Transparent Medical Records
Consumers Gaining Ground in Healthcare
Inviting Patients to Read Their Doctors' Notes: A Quasi-Experimental Study and a Look Ahead
Should Patients See Their Doctors’ Notes?
Implementation: Exclusions
All clinicians? Specialties (e.g., behavioral health) House staff Clinicians besides doctors
All notes? All notes open Options for clinicians to hide individual notes
All patients? Pilot with selected patients Individual clinician can exclude patient
Implementation: OpenNotes Roll-out
Institution’s culture impacts approaches to roll-outs
Big bang or phased rollout Phases by department
Opt-in or opt-out Mandatory for clinicians Chief’s permission to opt out Opt in
Implementation: Communications
Clinician communications It’s a culture change: communicate, communicate
Patient communications Often overlooked Marketing, media Note notifications
Big portal? BIDMC was 20% of patients, has doubled
Resources for Adopters
Visit our website www.myopennotes.org and sign up for the mailing list
Toolkit for implementers
Resources for evaluators
Roadmap and advice about key decisions Sample FAQs for patients and clinicians Communications checklist and sample materials
All open notes surveys are available free of charge Links to all open notes papers are on the website
Need something else? Contact us:
myopennotes@bidmc.harvard.edu
Future Directions Open notes and patient safety Open notes and mental health
Patients and clinicians co-generating notes Continued advocacy
Let’s discuss ...
Regional Activity
Who is sharing notes in Greater Columbus?
If you are interested in implementing open notes, contact Krista at krista@hcgc.org www.hcgc.org
Healthcare Transformation Learning Session
Text your questions via webinar option or to 614-906-2440
www.hcgc.org
THANK YOU! • Thank you for joining us today!
• Thanks to our speakers! • Thanks to our funding partners! • Please respond to the evaluation question via poll
Please save the dates for scheduled learning sessions
• Webinar: 9/24, 1-2PM Consumer Reports - Changes to Learn About Now • Webinar: 10/22, 1-2PM Expanding role of pharmacists in value-based healthcare • In-person: 12/5, 8:00-11:30AM Learning from regional partners
Lead Support
Major Support
Additional Support 100% of our Board of Directors & Staff Individual & Corporate Donations
www.hcgc.org