Evidence shows that successful management of complex health conditions requires the close collaboration of providers, patients, and their caregivers, and that the transparency made possible by health information technology may facilitate that collaboration. To help improve care for complex patients, Beth Israel Deaconess Medical Center (BIDMC) has received a $450,000 grant from The Commonwealth Fund to develop develop OurNotes, a new initiative for allowing patients, caregivers, and providers jointly create clinical notes and care plans within the shared EHR.
OurNotes: A New Strategy To Improve Treament for Complex Patients
OurNotes is an extension of the provider’s current OpenNotes program, a movement to offer patients ready, online access to their clinicians’ visit notes after an appointment or discussion. These notes are available on the PatientSite, the secure portal where patients can manage their health care online, anytime. Increasingly accepted by patients, families, providers and institutions throughout the United States, the number of patients who can read their medical notes online has risen to more than 5 million nationwide. This change in practice follows the encouraging findings of the OpenNotes study, published in the Annals of Internal Medicine in 2012. Led by investigators at BIDMC, the OpenNotes study involved more than 100 primary care doctors and 20,000 patients in three areas of the country.
How It Works
To begin, the research team will review previous research, interview experts, and convene focus groups to identify key elements of OurNotes and the process for co-generating clinical notes and care plans, including pre-visit histories and agendas and post visit follow-up plans.
“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,” said principal investigator, Jan Walker, RN, MBA, Division of General Medicine and Primary Care at BIDMC and Assistant Professor of Medicine at Harvard Medical School.
The team will then build prototypes and pilot the program in five health care organizations. Findings from this initial phase of work will be used to develop prototypes at each site and to conduct pilot testing that, in turn, will lead quickly toward formal clinical trials. If successful, this testing could possibly usher in a new way to improve care management for high-need, high-cost patients.
“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,” said Walker. “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.”
Grant Details
The Commonwealth Fund grant will support work at five sites, including original OpenNotes study partners:
-Beth Israel Deaconess Medical Center
– Geisinger Health System in Danville, PA
– Harborview Medical Center in Seattle, WA
– Recent OpenNotes adopters, Group Health Cooperative, also in Seattle and Mosaic Life Care in St. Joseph, MO
