New initiative will help patients view and add to physician EHR notes

Five primary care facilities will test a new initiative that will allow patients to not only view, but add to their physicians’ visit notes in their electronic health records (EHR) systems.

The initiative is being made possible by a $450,000 grant from The Commonwealth Fund to develop the OurNotes platform, which is an extension of the OpenNotes program to offer patients greater access to their electronic health information.

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The health centers involved in the pilot include the Israel Deaconess Medical Center (BIDMC) in Boston, as well as original OpenNotes study partners Geisinger Health System in Danville, Pa. and Harborview Medical Center in Seattle, Wash., and more recent OpenNotes participants Group Health Cooperative in Seattle and Mosaic Life Care in St. Joseph, Mo.

"We know that increasing patient engagement is a critical component of improving health care, and we hope to build on BIDMC's well-established work in this area," says Anne-Marie Audet, MD, vice president at The Commonwealth Fund. "This research will explore the potential for OurNotes to help improve care among the most medically complex patients–those with multiple chronic health conditions."

According to BIDMC, more than 5 million patients nationwide can now read their medical notes online-an effort spearheaded by a 2012 study at BIDMC that involved more than 100 PCPs and 20,000 patients.

"This is really building for the future. We envision the potential capability of OurNotes to range from allowing patients to, for example, add a list of topics or questions they'd like to cover during an upcoming visit, creating efficiency in that visit, to inviting patient to review and sign off on notes after a visit as way to ensure that patients and clinicians are on the same page," says principal investigator, Jan Walker, RN, MBA, of the division of general medicine and primary care at BIDMC and assistant professor of medicine at Harvard Medical School.

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"Our research has shown-and feedback from patients continues to confirm-that patients benefit from reading their visit notes. For example, patients say they have better recall of the treatment plan, feel more in control of their health care, and report improved adherence to medications," Walker adds. "We believe that OurNotes, which will enable patients to contribute to their own medical records, has the potential to further enhance communication and engage patients in managing illness more effectively and efficiently, leading to improved patient safety and quality of care and potentially, to lower health care costs."

The program will focus initially on primary care and involved not only patients and physicians, but also industry experts, who will all work together to develop a user-centered design.

"During this phase we'll be asking clinicians questions about what kinds of information they think would be helpful to receive from patients. Likewise, we'll be talking to patients to find out what kinds of information they would like to contribute to their records and their notes," Walker says.

Prototypes will be developed and phased into pilot programs at each site with the hope that they will result in formal clinical trials of the initiative, according to BIDMC.

"We envision OurNotes as a therapeutic intervention that will prove effective over time for a wide range of patients, especially those struggling with chronic health concerns," adds co-investigator Jonathan Darer, MD MPH, chief innovation officer at Geisinger Health System. "We expect this process to enlighten our understanding of patient and family engagement and its role in reducing healthcare costs, increased shared accountability, improving the health of those with chronic illness and multiple comorbidities and, most importantly, enhancing the overall patient experience of care.”