OpenNotes Initiative Advances Patient-Centered Care Transformation in Oregon

November 11, 2014   |  Tags: Blog   |  Tags: Interview
Amy Fellows, MPH and Homer Chin, MD, MS, We Can Do Better

OpenNotes is a national movement started by Beth Israel Deaconess Medical Center that urges health organizations to make clinician notes available to patients. The initiative’s goal is to encourage patients to become more active in their health care by giving them easy access to their physician’s notes following an appointment.

In February of 2013, We Can Do Better, an Oregon non-profit organization that engages citizens in identifying barriers and solutions to improving health and health care for all Oregonians, adopted OpenNotes as a major initiative in support of improving the health of all Oregonians. In September 2013, they formed the Northwest OpenNotes Consortium, with Dr. Homer Chin, retired Kaiser Permanente Associate Medical Director for Medical Informatics, as its chairperson.

Since then, nine prominent health systems and medical groups in the Northwest have collaborated to adopt the OpenNotes initiative, which marks the first time that it has been embraced simultaneously throughout an entire region. More than one million patients in Oregon and Southwest Washington have, or will soon have, the capability to securely access the notes their providers include in their patient medical records.

The Institute spoke with Amy Fellows, MPH, Executive Director of We Can Do Better, and Dr. Homer Chin, the physician champion for the Northwest OpenNotes Consortium, to learn more about this initiative and its impact on health care transformation in Oregon. Please contact Amy Fellows at amy@wecandobetter.org if you are interested in participating in the Northwest OpenNotes Consortium or receiving more information.

 

Q: How do you believe the OpenNotes initiative will support the health care transformation movement towards more patient-centered care already taking in place in Oregon?

OpenNotes is clearly an effective way to improve patient engagement. Patients who are able to access and read their doctor’s visit notes can better understand their medical condition and treatment plan. They are also able to review and share that information with family members and other caregivers. 

Q: What research and/or evidence is there that opening up visit notes to patients may help them become more actively involved with their health and health care? 

In 2011, a study done by researchers from Harvard Medical School showed that patients who were given access to their medical record notes reported remarkable improvements, including better understanding of their medical condition, improved recall of their care plan, feeling more in control of their care, and taking better care of themselves.

Moreover, 60 to 78 percent of patients in this large study reported doing better at taking medications as prescribed. The study included patients from various settings, including an urban population at the Beth Israel Deaconess Medical Center (Boston, MA), a rural population at Geisinger Health (rural Pennsylvania), and inner city patients at Harborview (Seattle, WA). The positive findings were similar in all three settings.  

Q: How has the Northwest OpenNotes Consortium approached health systems and medical groups in Oregon and SW Washington to educate them about this initiative and encourage them to participate?

The OpenNotes effort started with Dr. John Santa, Health Comparisons Director of Consumer Reports, speaking about it at the February 2013 We Can Do Better conference. Attendees were overwhelmingly interested in having more. In June of that year we invited Dr. Santa and the OpenNotes founders/researchers Tom Delbanco, MD and Jan Walker, RN from Beth Israel Deaconess Medical Center, to meet with health system leaders, policy makers and consumer groups and introduce them to OpenNotes.

There was enthusiastic interest at this first Oregon meeting that led to the development of the Northwest OpenNotes Consortium in September 2013. We started by approaching the Chief Medical Informatics Officers (CMIO) of the major health systems. The CMIOs would ultimately have to implement the functionality that would allow patients to view their notes through secure internet portals. 

Q: How would you describe the response the Consortium has received from organizations they have approached about this initiative?

The response has been very positive. Most organizations understand the enormous benefit and improvement in patient engagement that comes with adding this level of transparency to their patient encounters. 

Q: Has the Consortium experienced any resistance from health organizations?  If so, what were the causes of that resistance?

By and large, there has been strong support for moving forward from the leadership of these large health systems. Some concerns have been expressed by individual physicians within these organizations, but given the evidence of significant benefit, these organizations have moved forward to implement OpenNotes. We are concerned that it may be more difficult for smaller clinics/organizations to implement OpenNotes, as they typically do not have as many IT resources, and their EHR/patient portal vendor may not easily support making chart notes accessible to the patient. We are beginning to reach out to smaller organizations (and their EHR vendors) and are actively soliciting funding to support this work.

Q: Which health organizations in the NW have implemented or have committed to implementing OpenNotes as a health care standard?

Current members and their timing of implementing OpenNotes are:

  • US Department of Veterans Affairs -- January 2013 (predating our consortium)
  • Kaiser Permanente Northwest -- April 2014
  • OHSU Family Medicine Clinics -- April 2014
  • OCHIN Community Health Centers (functionality available on physician request) -- April 2014
  • The Portland Clinic -- July 2014
  • The Vancouver Clinic -- July 2014
  • Legacy – limited pilot in August 2014
  • Providence Health & Services -- TBD 2015
  • PeaceHealth – Vancouver Clinic, WA – October 2014 (plans to extend to their entire system in 2015)
  • Salem Health -- TBD 2015
  • Samaritan Health – July 2014 for radiology imaging reports; TBD 2015 for physician notes

Q: Have other regions been as successful in implementing OpenNotes?

Some organizations scattered across the country have been opening up their chart notes, but Oregon/SW Washington has the largest number of organizations opening their notes and is the first to do so as a regional effort.  

Q: What are the next steps for this movement on a regional and national level?

Regionally, we would like to begin adding smaller clinic groups to the consortium and support them in opening their notes. We also would like to get the word out to consumers so they are aware of possibility of directly accessing their physician’s notes and can either urge their doctors to open their notes or take advantage of this functionality if already available from their health care provider.

We are also available to help other regions around the nation in using a collaborative approach to opening their EHR notes.  Nationally, some organizations are beginning to look at opening their mental health and hospital inpatient notes as well. 

 

Amy Fellows, MPH is the Executive Director of We Can Do Better, whose mission is to create opportunities for nonpartisan civic education and engagement, bringing people together who share the values of better health care and health for all. Amy has over 14 years experience working with community health centers and other non-profit organizations serving the medically underserved on healthcare and health information technology projects.

 

Homer Chin, MD, MS is the physician champion for We Can Do Better’s Open Notes Consortium work. Dr. Chin was the associate medical director for medical informatics at Kaiser Permanente Northwest before his retirement in 2013. He led the pioneering work to implement an award winning comprehensive outpatient computer-based patient record at Kaiser Permanente in the 1990s.

Dr. Chin is on the affiliate faculty in the department of Medical Informatics and Outcomes Research at OHSU, a board member of OCHIN, a not-for-profit organization that provides information and management services to safety-net clinics in support of the medically underserved, and he is the advisory committee chairperson for OHITEC, Oregon’s Health Information Technology Extension Center. He was elected into the fellowship of the American College of Medical Informatics and completed an academic fellowship in medical informatics at Stanford University. Dr. Chin is a board-certified internist and continues to practice medicine part-time.