Patient-Centered Medical Home Transformation
Improving patient engagement by sharing provider notes Nationwide Children’s Hospital Aarti Chandawarkar, MD Cheryl Pippin, MD
Improving care coordination in patient-centered medical homes Central Ohio Primary Care Larry Blosser, MD, Medical Director Judy Minaudo, RN, Quality Improvement Manager
www.hcgc.org
Patient-Centered Medical Home Transformation
Improving patient engagement by sharing provider notes Nationwide Children’s Hospital Aarti Chandawarkar, MD Cheryl Pippin, MD
Improving care coordination in patient-centered medical homes Central Ohio Primary Care Larry Blosser, MD, Medical Director Judy Minaudo, RN, Quality Improvement Manager
www.hcgc.org
OpenNotes at Nationwide Children’s Hospital, Columbus Ohio ………………..……………………………………………………………………………………………………………………………………..
Project Aim • Implement OpenNotes using Epic’s MyChart patient portal. • To educate physicians about medical notes transparency. • Allay fears about change in workflows • Advocate for parent engagement in their child’s medical care.
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Pre implementation: Survey Monkey Poll Which issues do you think will cause you to alter what you put in a note because the patient can view it?
Obesity
49%
Mental Health/Substance Abuse
83%
Teen Sexual Disclosures
91%
ADHD
30%
foryou physical or will sexual abuse • WhichConcern issues do think cause you to alter what you put Maternal Anger in a note because the patient can view it? Munchausen’s ( by proxy)
81% 80% 78%
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Pre implementation: Survey Monkey Poll Yes
No
Do you think Open Notes will make face-to face visits longer?
36 %
67%
Do you think you will need to spend time addressing questions outside of visit time because of Open Notes?
77%
23%
Do you think you will spend more time on your 85% notes making them “patient friendly”?
15%
• Which issues do you think will cause you to alter what you put in a note because the patient can view it? ………………..……………………………………………………………………………………………………………………………………..
Obstacles to MyChart Sign-ups • Language barrier: Third of our visits need an interpreter. • Low MyChart interest: Over a 6month period, Total proxy codes generated (under 13years) 6674, out of which only 799 were activated. • Patient population with multiple limitations: No computer access, Limited ’minutes’ on the cellphone, • Marketing: Busy offices. Physicians/ Staff have limited time to discuss availability of OpenNotes.
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Obstacles to Open Notes Access • Little interest: Pediatrics is different from the adult world,. • AVS: Covers details of plan, immunizations, medications and patient instructions, which is what parents are interested in. • MyChart portal: is not intuitive, hard to find the progress note • Patient Education: Limited education for the families on how to access the progress note ………………..……………………………………………………………………………………………………………………………………..
ACT • Continue to promote and ask for My Chart sign up, maybe incentivize? • More “advertisement”, posters, step by step instructions where to find the note. • Consider community private primary care practice as a pilot to see if interest in Open Notes is higher. • Compare experiences of other sites similar to NCH ………………..……………………………………………………………………………………………………………………………………..