Evidence continues to mount that patients who get online access to their physicians’ clinical notes after medical visits are more engaged in their care and may improve safety by identifying documentation errors made by clinicians.

OpenNotes, a national movement that seeks to enhance communication through shared clinicians’ notes and fully transparent medical records, began in 2010 with an initial study that included more than 100 primary care doctors at three hospitals—Beth Israel Deaconess Medical Center (BIDMC) in Boston, Geisinger Health System in Danville, Penn., and Harborview Medical Center in Seattle—in which 20,000 patients were invited to read their visit notes through a secure website.

Since then, several studies have shown instances in which patient safety and quality of care that benefit from this kind of open communication between physicians and patients. Now, a pilot conducted at BIDMC has demonstrated the value of an OpenNotes patient reporting tool in engaging patients and improving patient safety, without any associated negative consequences for clinician workflow or patient-clinician relationships.

Beth Israel Deaconess Medical Center

Results of the BIDMC pilot were published last week in the British Medical Journal (BMJ) Quality and Safety. A simple, low-cost, online feedback tool was created for the one-year pilot that patients could link to from their notes on a secure patient portal.

Overall, there were 6,225 patients invited through a patient portal to provide note feedback in the pilot, of which 44 percent of patients read notes; one in 12 patients used the tool, submitting 260 reports.

“Nearly all (96 percent) respondents reported understanding the note. Patients and care partners documented potential safety concerns in 23 percent of reports; 2 percent did not understand the care plan; and 21 percent reported possible mistakes, including medications, existing health problems, something important missing from the note or current symptoms,” states the article. “Among these, 64 percent were definite or possible safety concerns on clinician review, and 57 percent of cases confirmed with patients resulted in a change to the record or care.”

In fact, according to the article’s authors, the tool far exceeded the reporting rate of BIDMC’s ambulatory online clinician adverse event reporting system.

“Our findings add to a growing literature suggesting that patients can help identify mistakes,” says lead author Sigall Bell, MD, OpenNotes director of patient safety and discovery as well as associate professor of medicine at Harvard Medical School. “We were struck that nearly all patients and care partners in the study found the feedback tool valuable. What that indicates to us is that patients are eager to help their healthcare teams get it right.”

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Further, 99 percent of patients and care partners found the tool valuable; 97 percent wanted it to continue; 98 percent reported unchanged or improved relationships with their clinician; and none of the providers in the pilot reported worsening workflow or relationships with patients.

“We were pleased to find that the OpenNotes reporting tool helped to identify quality improvement opportunities without appearing to add to clinician burden,” adds Bell. “We believe that if patients know their feedback is welcome and encouraged, the potential to reduce errors or clear up confusion about the care plan will be even greater.”

The research was funded by CRICO, the medical malpractice insurer and patient safety supporter of the Harvard hospitals. Currently, the OpenNotes patient reporting tool is being piloted at Boston Children’s Hospital in most of its clinics.

“This particular BIDMC pilot study was really taking the next step in our evolution of developing OpenNotes as a tool for patient engagement,” concludes Bell. “We’re really excited about the Boston Children’s Hospital pilot and continue to think about other opportunities for expansion.”

OpenNotes continues to gain momentum across the country. As of August, more than 10 million patients nationwide have access to their doctors’ notes online. Last year, four foundations committed $10 million to increase the number of OpenNotes participants to 50 million patients nationally over three years.

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