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How OpenNotes and Portals Improve Patient Engagement

By Vera Gruessner

- The healthcare industry has been focused on improving patient engagement across the medical care spectrum in efforts to boost health outcomes. Both Stage 2 and Stage 3 Meaningful Use requirements under the Medicare and Medicaid EHR Incentive Programs have specific objectives centered on enhancing patient engagement. Healthcare providers have been aiming to meet these requirements, which has brought forth patient portal implementations throughout many hospitals and clinics.

Patient Portals and OpenNotes

Along with patient portals, it may be beneficial for patients to access notes that their physicians write during a physical exam or a typical visit, according to researchers from the Beth Israel Deaconess Medical Center (BIDMC). A press release from BIDMC states that following a format that allows users to access their physicians’ notes – a program called OpenNotes – could improve patient safety as well as the overall quality of care.

“What we heard from patients and doctors fell into recognizable categories - for example, catching medication errors, better remembering next steps and improved plan adherence, enhanced error reporting, improved coordination of care for informal caregivers of vulnerable patients with many providers and appointments, and reduced diagnostic delay,” stated lead author Sigall Bell, MD, in the Division of General Medicine and Primary Care and Assistant Professor of Medicine at Harvard Medical School.

“In many common safety categories, it appears that having the patient’s or an informal caregiver’s eyes on clinical notes can help ensure care is safer. Doctors review hundreds or thousands of charts; patients review one: their own. OpenNotes may have a unique role in connecting patients and clinicians in the space between visits.”

The OpenNotes study started in 2010, which allowed more than 20,000 patients across three hospitals to access their doctors’ notes through a patient portal. This program boosted patient engagement in the sense that these individuals felt more control over their health and were better able to manage their physician visits.

At this point in time, more than 5 million patients are able to view their physician notes since the program launch has expanded across the healthcare spectrum. Essentially, this has expanded the physician-patient relationship and communication channels between these two subjects toward more quality care.

The OpenNotes program enables patients to remember their medication regimen as well as what was mentioned in the office visits, which all brings greater patient engagement and better outcomes. Some patients even noticed errors in their electronic health records and ensured that these mistakes were corrected. This shows that the OpenNotes program could actually reduce medical errors as well.

“These are all examples of patients who used the notes to engage in their own health care and to play active roles in making their care better,” Bell said in a public statement. “The message that we are getting from many patients is that they want to participate in their care. And while the responsibility for patient safety still rests primarily with health care organizations, this research shows us what’s possible when we make space at the table for patients.”

While patient portals and the ability to view physician notes improves patient engagement across the healthcare spectrum, there are some concerns that physicians have expressed with the OpenNotes program. For instance, how would this process impact trust between patients and providers if the consumers notice errors in their records?

Also, what would be the process of defining errors and reporting these problems? These and other concerns will need to be addressed among healthcare organizations to develop a more effective solution when implementing portals and OpenNotes.

Nonetheless, allowing patients to view these notes along with opening up a dialogue between consumers and providers is a sure way to improve patient engagement, quality of care, and health outcomes.


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