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Walker J, Leveille S, Bell S, Chimowitz H, Dong Z, Elmore JG, Fernandez L, Fossa A, Gerard M, Fitzgerald P, Harcourt K, Jackson S, Payne TH, Perez J, Shucard H, Stametz R, DesRoches C, Delbanco T. OpenNotes After 7 Years: Patient Experiences With Ongoing Access to Their Clinicians' Outpatient Visit Notes. J Med Internet Res 2019; 21:e13876. [PMID: 31066717 PMCID: PMC6526690 DOI: 10.2196/13876] [Citation(s) in RCA: 164] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 01/03/2023] Open
Abstract
Background Following a 2010-2011 pilot intervention in which a limited sample of primary care doctors offered their patients secure Web-based portal access to their office visit notes, the participating sites expanded OpenNotes to nearly all clinicians in primary care, medical, and surgical specialty practices. Objective The aim of this study was to examine the ongoing experiences and perceptions of patients who read ambulatory visit notes written by a broad range of doctors, nurses, and other clinicians. Methods A total of 3 large US health systems in Boston, Seattle, and rural Pennsylvania conducted a Web-based survey of adult patients who used portal accounts and had at least 1 visit note available in a recent 12-month period. The main outcome measures included patient-reported behaviors and their perceptions concerning benefits versus risks. Results Among 136,815 patients who received invitations, 21.68% (29,656/136,815) responded. Of the 28,782 patient respondents, 62.82% (18,081/28,782) were female, 72.90% (20,982/28,782) were aged 45 years or older, 76.94% (22,146/28,782) were white, and 14.30% (4115/28,782) reported fair or poor health. Among the 22,947 who reported reading 1 or more notes, 3 out of 4 reported reading them for 1 year or longer, half reported reading at least 4 notes, and 37.74% (8588/22,753) shared a note with someone else. Patients rated note reading as very important for helping take care of their health (16,354/22,520, 72.62%), feeling in control of their care (15,726/22,515, 69.85%), and remembering the plan of care (14,821/22,516, 65.82%). Few were very confused (737/22,304, 3.3%) or more worried (1078/22,303, 4.83%) after reading notes. About a third reported being encouraged by their clinicians to read notes and a third told their clinicians they had read them. Less educated, nonwhite, older, and Hispanic patients, and individuals who usually did not speak English at home, were those most likely to report major benefits from note reading. Nearly all respondents (22,593/22,947, 98.46%) thought Web-based access to visit notes a good idea, and 62.38% (13,427/21,525) rated this practice as very important for choosing a future provider. Conclusions In this first large-scale survey of patient experiences with a broad range of clinicians working in practices in which shared notes are well established, patients find note reading very important for their health management and share their notes frequently with others. Patients are rarely troubled by what they read, and those traditionally underserved in the United States report particular benefit. However, fewer than half of clinicians and patients actively address their shared notes during visits. As the practice continues to spread rapidly in the United States and internationally, our findings indicate that OpenNotes brings benefits to patients that largely outweigh the risks.
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Affiliation(s)
- Jan Walker
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Suzanne Leveille
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.,College of Nursing and Health Sciences, University of Massachusetts, Boston, MA, United States
| | - Sigall Bell
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Hannah Chimowitz
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Zhiyong Dong
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Joann G Elmore
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Leonor Fernandez
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Alan Fossa
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Macda Gerard
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Patricia Fitzgerald
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Kendall Harcourt
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Sara Jackson
- Division of General Internal Medicine, School of Medicine, University of Washington, Seattle, WA, United States
| | - Thomas H Payne
- Division of General Internal Medicine, School of Medicine, University of Washington, Seattle, WA, United States.,Department of Medicine, Medicine Information Technology Services, University of Washington, Seattle, WA, United States
| | - Jocelyn Perez
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Hannah Shucard
- Division of General Internal Medicine, School of Medicine, University of Washington, Seattle, WA, United States
| | - Rebecca Stametz
- Steele Institute for Health Innovation, Geisinger, Danville, PA, United States
| | - Catherine DesRoches
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
| | - Tom Delbanco
- Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
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Woolen SA, Kazerooni EA, Steenburg SD, Nan B, Ma T, Wall A, Linna NB, Gayed MJ, Kushdilian MV, Parent K, Cahalan S, Alameddine M, Ladd LM, Davenport MS. Optimizing Electronic Release of Imaging Results through an Online Patient Portal. Radiology 2018; 290:136-143. [PMID: 30398436 DOI: 10.1148/radiol.2018180883] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To determine an optimal embargo period preceding release of radiologic test results to an online patient portal. Materials and Methods This prospective discrete choice conjoint survey with modified orthogonal design was administered to patients by trained interviewers at four outpatient sites and two institutions from December 2016 to February 2018. Three preferences for receiving imaging results associated with a possible or known cancer diagnosis were evaluated: delay in receipt of results (1, 3, or 14 days), method of receipt (online portal, physician's office, or phone), and condition of receipt (before, at the same time as, or after health care provider). Preferences (hereafter, referred to as utilities) were derived from parameter estimates (β) of multinomial regression stratified according to study participant and choice set. Results Among 464 screened participants, the response and completion rates were 90.5% (420 of 464) and 99.5% (418 of 420), respectively. Participants preferred faster receipt of results (P < .001) from their physician (P < .001) over the telephone (P < .001). Each day of delay decreased preference by 13 percentage points. Participants preferred immediate receipt of results through an online portal (utility, -.57) if made to wait more than 6 days to get results in the office and more than 11 days to get results by telephone. Compared with receiving results in their physician's office on day 7 (utility, -.60), participants preferred immediate release through the online portal without physician involvement if followed by a telephone call within 6 days (utility, -0.49) or an office visit within 2 days (utility, -.53). Older participants preferred physician-directed communication (P < .001). Conclusion The optimal embargo period preceding release of results through an online portal depends on the timing of traditional telephone- and office-based styles of communication. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Arenson et al in this issue.
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Affiliation(s)
- Sean A Woolen
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Ella A Kazerooni
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Scott D Steenburg
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Bin Nan
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Tianwen Ma
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Amber Wall
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Nathaniel B Linna
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Matthew J Gayed
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Michael V Kushdilian
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Kelly Parent
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Shannon Cahalan
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Mitchell Alameddine
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Lauren M Ladd
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
| | - Matthew S Davenport
- From the Departments of Radiology (S.A.W., E.A.K., M.S.D.), Biostatistics (B.N., T.M.), Patient and Family Centered Care (A.W., S.C., M.A.), and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, B2-A209P, Ann Arbor, MI 48109; Michigan Radiology Quality Collaborative, Ann Arbor, Mich (S.A.W., E.A.K., M.S.D.); Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Ind (S.D.S., N.B.L., M.J.G., M.V.K., L.M.L.); and Department of Patient and Family Experience, Beaumont Health, Royal Oak, Mich (K.P.)
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