Background:The project opened up the clinical record to the patient.
Process: After the patient saw the provider and the record was signed by the doctor the patient was sent a secure email simply alerting them that they could re
ad the visit note and then 2 weeks prior to their next visit they got a reminder suggesting that they review the notes..
Keep it simple, no educating, cajoling, just open it up for one year. (thanks to Steve Downs at RWJF)
Slide 1 (time on video 20:19)19,000 Patients of whom 13,000 had a visit in the year of the study.
105 volunteer Primary Care Physicans
3 sites - Beth Israel, Geisenger and Harborview Medical Center (Seattle)
Slide 2 (21:22 on video)
3 core questions (no idea how to engage patients)
- Does OpenNotes help patients become more engaged in their care?
- Is OpenNotes the straw that breaks the doctors back?
- After 1 year, will patients and doctors want to continue?
Slide 3 Patients were Enthusiastic (22:15)
Patients used the notes
- Up to 92% of patients across all 3 sites read their doctors note(s).
- At Geisenger 87% read every single one of their notes.
- Feeling more in control of their care (77% to 85%)
- Better understanding of thealth and medical conditions (77% to 85%)
- Doing better with taking their medications (60% to 78%) -
(23:15) Tome Deblanco, MD Beth Israel Deaconess Medical Center "even if this was a five fold exageration and only a 15% increase in medication adherence we would apply for the Nobel Prize in Medicine"
Patients were rarely (1 - 8% ) confused, worried or offended by what they read in their doctors notes.(*this was the number one concern by 80% of doctors who didn't want to participate in the study)
Slide 4 Impact on Doctors - benefits with little disruption (24:40)
Many doctors reported strengthen relationships with their patients. (Felt safer with another set of eyes watching)
Some doctors change how they wrote notes
- 0 - 21% reporting taking more time to write notes to be more educational
- 3 - 36% reported changing the way they wrote about mental health, substance, abuse, cancer and obesity
Few doctors reported impacts on their workflow
- Longer visits (0 - 5%) but some took less time so it was a wash
- More time addressing patients questions outside of visits
- Some doctors even wondered if anyone was reading them (when 9 in 10 did)
Slide 5 - New Medicine - Towards a new Standard of Care (26:15)"We think of this as a new medicine.. I hope will become a new standard of care".. "This medicine is designed to help the vast majority of patients and to help those that care for them as well. I can't emphasize this enough - This isn't just a patient intervention -I think it will make the life of the doctor or the nurse or the caregivers richer as they get used to it."
- Designed to help the vast majority of patients and those who care for them
- Rarely contraindicated
- Patients and providers will learn to use it widely and well
27:25 Bottom Line (no slide)
- 99% of patients wanted to continue with continue - never heard of 99%
- 85% said it would be important in choice of care giver.
- Not one doctor stopped after a year - not all loved it but they all felt it was important to continue
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