Journal
JOURNAL OF PATIENT SAFETY
Volume 17, Issue 8, Pages E791-E799Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/PTS.0000000000000494
Keywords
patient safety; ambulatory care; health information technology; information transparency; diagnostic accuracy; healthcare quality improvement
Funding
- Controlled Risk Insurance Company/Risk Management Foundation of the Harvard Medical Institutions
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The study found that patients and parents believe that reading clinical notes helps them understand and follow through on tests and referrals. The majority of participants reported improvements in trust in the provider, activation, patient-provider goal alignment, and teamwork after reading the notes.
Background Ambulatory safety risks including delayed diagnoses or missed abnormal test results are difficult for clinicians to see, because they often occur in the space between visits. Experts advocate greater patient engagement to improve safety, but strategies are limited. Patient access to clinical notes (OpenNotes) may help close the safety gap between visits. Methods We surveyed patients and families who logged on to the patient portal and had at least one ambulatory note available in the past 12 months at two academic hospitals during June to September 2016, focusing on patient-reported effects of OpenNotes on safety knowledge, behaviors, and attitudes. Results A total of 6913 (28%) of 24,722 patients at an adult hospital and 3672 (17%) of 21,579 participants at the children's hospital submitted surveys. Approximately 75% of patients and parents each reported that reading notes helped them understand the reason for both tests and referrals, and approximately 50% felt that it helped them complete tests and referrals. Roughly 75% of participants were more likely to check and understand test results. Overall, 97% of participants reported that trust in the provider, activation, patient-provider goal alignment, and teamwork were each better or the same after reading 1 note or more. Nonwhite participants and those with high school education or less were 30% to 50% more likely to report that reading notes helped them complete tests compared with white and more educated respondents, respectively. Conclusions Overall, the majority of more than 10,000 patients and parents reported reading notes helped them understand and follow through on tests and referrals. As information transparency spreads, OpenNotes can help activate patients and families, facilitate safety behaviors, and forge stronger partnerships with clinicians.
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