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OpenNotes: Patient engagement with low physician hassle
ORLANDO – Early evidence suggests that OpenNotes is helping to engage patients and improve health outcomes while not creating undue burden for physicians.
A 2010 pilot project at Beth Israel Deaconess Medical Center in Boston, Geisinger Health System in Pennsylvania, and Harborview Medical Center in Seattle tested OpenNotes, a program that allows patients to see the entirety of a physician’s notes within their medical record and not just a summarized version.
Homer Chin, MD, of the department of medical informatics and outcomes research at Oregon Health & Science University, Portland, an associate with the OpenNotes Program, and physician champion for the Northwest OpenNotes Consortium, noted that a survey of the 105 primary care physicians participating in the pilot revealed they were apprehensive when they heard their visit notes would be completely available to patients.
Prior to the launch of the pilot, 24% of physicians expected significantly longer visits because of the availability of OpenNotes, 42% said they expected to spend more time addressing patient questions outside of visits, and 39% said they expected to spend more time writing/editing/dictating notes, Dr. Chin said at the annual meeting of the Healthcare Information and Management Systems Society.
Their concerns never quite materialized.
According to a survey of the participating physicians after the yearlong pilot, only 2% reported visits took significantly longer, 3% said they spent more time addressing patient questions outside of visits, and 11% said they spent more time writing/editing/dictating notes.
With regard to writing notes, “what we are finding is that most physicians are saying they are changing the way they write the note a little bit, but it is not taking more time,” Dr. Chin said. “They are just watching for certain terms and writing them in a different way, but it is not necessarily taking more time.”
More than 70% of patients who participated in the trial reported they are taking better care of themselves, more than 77% said they have a better understanding of their medical condition, more than 69% said they are better prepared for visits and more than 60% said they are more adherent to their prescription medication regimens.
Importantly, 85% said the availability of OpenNotes would affect their future choice of providers.
Dr. Chin also discussed the results of a survey of patients using OpenNotes in the Virginia Commonwealth University Health System in Richmond, noting that of roughly 420 respondents, 70% said their contact with their providers did not change, with nearly 20% saying they were contacting their provider less. Just over 40% said that reading their notes made them less worried about something health related, while a little more than 50% said there was no change. Nearly 85% said they thought seeing the notes helped them take better care of themselves. Nearly 90% of patients said that they understood some or all of their doctors’ notes.
It has been incredibly valuable “when the patients use the portal to prepare themselves for the visit with the provider,” Mr. Kravitz said. “They will review their case. They’ll look at past x-rays or reports, any kind of information, the results for laboratory and anything else, but they will message their provider. They are very heavy into messaging. It’s secure messaging within the portal and any type of questions, especially after they’ve had an appointment, they’ve thought of something they didn’t think about in the appointment, they have the opportunity to message back to the provider’s office.”
Geisinger saw 620,000 encounter reviews in OpenNotes out of 2 million patient visits in its last fiscal year, with virtually no complaints about the information in the OpenNotes.
Dr. Chin stressed that the implemented OpenNotes needs to be driven by physicians.
“I would emphasize that this has to be a clinician operational leader supported effort, and not an IT effort, so that when clinicians complain, you can point them to their department head, the chief medical officer, and not the IT people,” he said. “You’ve got to have good communication to providers. Our advice is to start with one department. You might do a pilot for a very short period of time, but there is enough evidence now to really implement it throughout the organization. We encourage people not to allow individual providers to opt out on their own, to make their own decision to opt out, to do it as an organizational effort.”
Michael Day, chief information officer of Ascension Health and Columbia St. Mary’s Health System of Milwaukee, offered the same advice.
“You’ve got to have leadership commitment up front,” Mr. Day said. “This really has to have good, strong physician leadership. The key executive in charge of all of this was the president of our medical group which drove a lot of the change with a lot of support from other areas.”
He noted that at his organization there was “a lot of physician grumbling” when OpenNotes was announced. However, there has been “relatively no impact. I think they’ve all agreed that this has made care better. We’ve also seen an actual improvement in the quality of the documentation.”
None of the presenters reported any conflicts of interest.
ORLANDO – Early evidence suggests that OpenNotes is helping to engage patients and improve health outcomes while not creating undue burden for physicians.
A 2010 pilot project at Beth Israel Deaconess Medical Center in Boston, Geisinger Health System in Pennsylvania, and Harborview Medical Center in Seattle tested OpenNotes, a program that allows patients to see the entirety of a physician’s notes within their medical record and not just a summarized version.
Homer Chin, MD, of the department of medical informatics and outcomes research at Oregon Health & Science University, Portland, an associate with the OpenNotes Program, and physician champion for the Northwest OpenNotes Consortium, noted that a survey of the 105 primary care physicians participating in the pilot revealed they were apprehensive when they heard their visit notes would be completely available to patients.
Prior to the launch of the pilot, 24% of physicians expected significantly longer visits because of the availability of OpenNotes, 42% said they expected to spend more time addressing patient questions outside of visits, and 39% said they expected to spend more time writing/editing/dictating notes, Dr. Chin said at the annual meeting of the Healthcare Information and Management Systems Society.
Their concerns never quite materialized.
According to a survey of the participating physicians after the yearlong pilot, only 2% reported visits took significantly longer, 3% said they spent more time addressing patient questions outside of visits, and 11% said they spent more time writing/editing/dictating notes.
With regard to writing notes, “what we are finding is that most physicians are saying they are changing the way they write the note a little bit, but it is not taking more time,” Dr. Chin said. “They are just watching for certain terms and writing them in a different way, but it is not necessarily taking more time.”
More than 70% of patients who participated in the trial reported they are taking better care of themselves, more than 77% said they have a better understanding of their medical condition, more than 69% said they are better prepared for visits and more than 60% said they are more adherent to their prescription medication regimens.
Importantly, 85% said the availability of OpenNotes would affect their future choice of providers.
Dr. Chin also discussed the results of a survey of patients using OpenNotes in the Virginia Commonwealth University Health System in Richmond, noting that of roughly 420 respondents, 70% said their contact with their providers did not change, with nearly 20% saying they were contacting their provider less. Just over 40% said that reading their notes made them less worried about something health related, while a little more than 50% said there was no change. Nearly 85% said they thought seeing the notes helped them take better care of themselves. Nearly 90% of patients said that they understood some or all of their doctors’ notes.
It has been incredibly valuable “when the patients use the portal to prepare themselves for the visit with the provider,” Mr. Kravitz said. “They will review their case. They’ll look at past x-rays or reports, any kind of information, the results for laboratory and anything else, but they will message their provider. They are very heavy into messaging. It’s secure messaging within the portal and any type of questions, especially after they’ve had an appointment, they’ve thought of something they didn’t think about in the appointment, they have the opportunity to message back to the provider’s office.”
Geisinger saw 620,000 encounter reviews in OpenNotes out of 2 million patient visits in its last fiscal year, with virtually no complaints about the information in the OpenNotes.
Dr. Chin stressed that the implemented OpenNotes needs to be driven by physicians.
“I would emphasize that this has to be a clinician operational leader supported effort, and not an IT effort, so that when clinicians complain, you can point them to their department head, the chief medical officer, and not the IT people,” he said. “You’ve got to have good communication to providers. Our advice is to start with one department. You might do a pilot for a very short period of time, but there is enough evidence now to really implement it throughout the organization. We encourage people not to allow individual providers to opt out on their own, to make their own decision to opt out, to do it as an organizational effort.”
Michael Day, chief information officer of Ascension Health and Columbia St. Mary’s Health System of Milwaukee, offered the same advice.
“You’ve got to have leadership commitment up front,” Mr. Day said. “This really has to have good, strong physician leadership. The key executive in charge of all of this was the president of our medical group which drove a lot of the change with a lot of support from other areas.”
He noted that at his organization there was “a lot of physician grumbling” when OpenNotes was announced. However, there has been “relatively no impact. I think they’ve all agreed that this has made care better. We’ve also seen an actual improvement in the quality of the documentation.”
None of the presenters reported any conflicts of interest.
ORLANDO – Early evidence suggests that OpenNotes is helping to engage patients and improve health outcomes while not creating undue burden for physicians.
A 2010 pilot project at Beth Israel Deaconess Medical Center in Boston, Geisinger Health System in Pennsylvania, and Harborview Medical Center in Seattle tested OpenNotes, a program that allows patients to see the entirety of a physician’s notes within their medical record and not just a summarized version.
Homer Chin, MD, of the department of medical informatics and outcomes research at Oregon Health & Science University, Portland, an associate with the OpenNotes Program, and physician champion for the Northwest OpenNotes Consortium, noted that a survey of the 105 primary care physicians participating in the pilot revealed they were apprehensive when they heard their visit notes would be completely available to patients.
Prior to the launch of the pilot, 24% of physicians expected significantly longer visits because of the availability of OpenNotes, 42% said they expected to spend more time addressing patient questions outside of visits, and 39% said they expected to spend more time writing/editing/dictating notes, Dr. Chin said at the annual meeting of the Healthcare Information and Management Systems Society.
Their concerns never quite materialized.
According to a survey of the participating physicians after the yearlong pilot, only 2% reported visits took significantly longer, 3% said they spent more time addressing patient questions outside of visits, and 11% said they spent more time writing/editing/dictating notes.
With regard to writing notes, “what we are finding is that most physicians are saying they are changing the way they write the note a little bit, but it is not taking more time,” Dr. Chin said. “They are just watching for certain terms and writing them in a different way, but it is not necessarily taking more time.”
More than 70% of patients who participated in the trial reported they are taking better care of themselves, more than 77% said they have a better understanding of their medical condition, more than 69% said they are better prepared for visits and more than 60% said they are more adherent to their prescription medication regimens.
Importantly, 85% said the availability of OpenNotes would affect their future choice of providers.
Dr. Chin also discussed the results of a survey of patients using OpenNotes in the Virginia Commonwealth University Health System in Richmond, noting that of roughly 420 respondents, 70% said their contact with their providers did not change, with nearly 20% saying they were contacting their provider less. Just over 40% said that reading their notes made them less worried about something health related, while a little more than 50% said there was no change. Nearly 85% said they thought seeing the notes helped them take better care of themselves. Nearly 90% of patients said that they understood some or all of their doctors’ notes.
It has been incredibly valuable “when the patients use the portal to prepare themselves for the visit with the provider,” Mr. Kravitz said. “They will review their case. They’ll look at past x-rays or reports, any kind of information, the results for laboratory and anything else, but they will message their provider. They are very heavy into messaging. It’s secure messaging within the portal and any type of questions, especially after they’ve had an appointment, they’ve thought of something they didn’t think about in the appointment, they have the opportunity to message back to the provider’s office.”
Geisinger saw 620,000 encounter reviews in OpenNotes out of 2 million patient visits in its last fiscal year, with virtually no complaints about the information in the OpenNotes.
Dr. Chin stressed that the implemented OpenNotes needs to be driven by physicians.
“I would emphasize that this has to be a clinician operational leader supported effort, and not an IT effort, so that when clinicians complain, you can point them to their department head, the chief medical officer, and not the IT people,” he said. “You’ve got to have good communication to providers. Our advice is to start with one department. You might do a pilot for a very short period of time, but there is enough evidence now to really implement it throughout the organization. We encourage people not to allow individual providers to opt out on their own, to make their own decision to opt out, to do it as an organizational effort.”
Michael Day, chief information officer of Ascension Health and Columbia St. Mary’s Health System of Milwaukee, offered the same advice.
“You’ve got to have leadership commitment up front,” Mr. Day said. “This really has to have good, strong physician leadership. The key executive in charge of all of this was the president of our medical group which drove a lot of the change with a lot of support from other areas.”
He noted that at his organization there was “a lot of physician grumbling” when OpenNotes was announced. However, there has been “relatively no impact. I think they’ve all agreed that this has made care better. We’ve also seen an actual improvement in the quality of the documentation.”
None of the presenters reported any conflicts of interest.
AT HIMSS 2017
CMS to alert docs of their MIPS status soon
ORLANDO – Want to know if you must participate in the new MIPS program? CMS is about to let you know.
Physicians who are right around the eligibility threshold for participation in the Quality Payment Program “want to know if they are eligible” for the Merit-based Incentive Payment System (MIPS), one of the QPP’s two tracks, Kate Goodrich, MD, said at the annual meeting of the Healthcare Information Management Systems Society. Within the next 6 weeks – about the first week of April – the Centers for Medicare & Medicaid Services will notify practices with less than $30,000 in Medicare payments or that serve less than 100 Medicare patients if they are exempt.
- Do the bare minimum and face no penalties.
- Submit 90 days worth of data and be eligible for a small bonus payment.
- Submit for the full year and be eligible for the full bonus that is to be determined.
Doing absolutely nothing will result in a 4% reduction in Medicare fee schedule payments in 2019.
“We have to expect that we will have some folks who do the minimum” in 2017, Dr. Goodrich, director of the Center for Clinical Standards and Quality and the chief medical officer for CMS, said. “They are just not ready to go beyond that. But even for folks who haven’t participated previously [in reporting programs], we are hearing they want to at least try to do more than just the bare minimum because they want to get ready for future years of the program.”
She said that CMS officials “are definitely hearing from some larger health systems, but even some medium and smaller practices that were really familiar with what we now call legacy programs, so meaningful use and PQRS [Physician Quality Reporting System] and so forth, that they’re ready.”
ORLANDO – Want to know if you must participate in the new MIPS program? CMS is about to let you know.
Physicians who are right around the eligibility threshold for participation in the Quality Payment Program “want to know if they are eligible” for the Merit-based Incentive Payment System (MIPS), one of the QPP’s two tracks, Kate Goodrich, MD, said at the annual meeting of the Healthcare Information Management Systems Society. Within the next 6 weeks – about the first week of April – the Centers for Medicare & Medicaid Services will notify practices with less than $30,000 in Medicare payments or that serve less than 100 Medicare patients if they are exempt.
- Do the bare minimum and face no penalties.
- Submit 90 days worth of data and be eligible for a small bonus payment.
- Submit for the full year and be eligible for the full bonus that is to be determined.
Doing absolutely nothing will result in a 4% reduction in Medicare fee schedule payments in 2019.
“We have to expect that we will have some folks who do the minimum” in 2017, Dr. Goodrich, director of the Center for Clinical Standards and Quality and the chief medical officer for CMS, said. “They are just not ready to go beyond that. But even for folks who haven’t participated previously [in reporting programs], we are hearing they want to at least try to do more than just the bare minimum because they want to get ready for future years of the program.”
She said that CMS officials “are definitely hearing from some larger health systems, but even some medium and smaller practices that were really familiar with what we now call legacy programs, so meaningful use and PQRS [Physician Quality Reporting System] and so forth, that they’re ready.”
ORLANDO – Want to know if you must participate in the new MIPS program? CMS is about to let you know.
Physicians who are right around the eligibility threshold for participation in the Quality Payment Program “want to know if they are eligible” for the Merit-based Incentive Payment System (MIPS), one of the QPP’s two tracks, Kate Goodrich, MD, said at the annual meeting of the Healthcare Information Management Systems Society. Within the next 6 weeks – about the first week of April – the Centers for Medicare & Medicaid Services will notify practices with less than $30,000 in Medicare payments or that serve less than 100 Medicare patients if they are exempt.
- Do the bare minimum and face no penalties.
- Submit 90 days worth of data and be eligible for a small bonus payment.
- Submit for the full year and be eligible for the full bonus that is to be determined.
Doing absolutely nothing will result in a 4% reduction in Medicare fee schedule payments in 2019.
“We have to expect that we will have some folks who do the minimum” in 2017, Dr. Goodrich, director of the Center for Clinical Standards and Quality and the chief medical officer for CMS, said. “They are just not ready to go beyond that. But even for folks who haven’t participated previously [in reporting programs], we are hearing they want to at least try to do more than just the bare minimum because they want to get ready for future years of the program.”
She said that CMS officials “are definitely hearing from some larger health systems, but even some medium and smaller practices that were really familiar with what we now call legacy programs, so meaningful use and PQRS [Physician Quality Reporting System] and so forth, that they’re ready.”
AT HIMSS 2017
Want better patient engagement? Use social media
ORLANDO – Looking for a better way to reach your patients and guide them to being more engaged in their own health care? Then expand your social media presence.
That was the message Kevin Campbell, MD, a cardiologist at the University of North Carolina, Chapel Hill, told attendees at the annual meeting of the Healthcare Information and Management Systems Society.
“Social media is where our patients, customers, and consumers, as well as our colleagues are and where we need to be,” Dr. Campbell said.
He called out three specific social media tools – Twitter, Facebook Live, and blogging – as the most effective for physicians. The first two offer a key way to connect with patients and colleagues – the ability to use video.
“The most important thing out in the digital space in terms of engagement is video and the visual,” Dr. Campbell said. “You’ll get 6,000% more engagement with a video-type point of contact. That can be a link from Twitter or it can be a Facebook Live [session] or a YouTube video.”
Video messaging also helps doctors support their peers, Dr. Campbell said.
“We can provide timely information to our colleagues,” he noted. “We have Twitter chats with fellows-in-training … I can talk to fellows who are in Germany about a technique we’re using here and then they can learn more about that technique.”
Secure social media channels also can be used to share thoughts and ideas regarding a clinical query regarding a specific test or imaging result, he said.
“The patient benefits because there are more brains thinking about their problem,” he noted.
Blogging also can be effective for reaching out to patients and colleagues as it provides a way to disseminate information on topics such as new treatments or learning about disease states.
But if the blog is set up to be interactive, doctors can get insights into their patients’ health concerns, Dr. Campbell said.
“I let patients write on my blog and I actually learn a ton about the patient experience,” he said. “I don’t even think of X, Y, and Z situation. I will be more empathetic to this because of what [they] told me.”
The caveat, of course, is that specific, protected information cannot be shared or posted.
“The attorneys will really get upset,” he noted. “So you do not develop a legal duty to that patient. But you can talk about treatments and what’s out there and what’s available. ... There may be a new treatment for leukemia that’s experimental that’s coming out of a university in Philadelphia and I can talk about that treatment.”
Dr. Campbell also said social media can be effective for doctors to promote themselves, pointing to his own career where he serves as a regular commentator on both the national and local levels. Engaging with media outlets can help turn a doctor into a key opinion leader, he said.
“If you say something important, engage about important issues, patients, consumers, industry partners and other leaders in the field are going to engage with you,” he said.
Dr. Campbell reported no conflicts of interest.
ORLANDO – Looking for a better way to reach your patients and guide them to being more engaged in their own health care? Then expand your social media presence.
That was the message Kevin Campbell, MD, a cardiologist at the University of North Carolina, Chapel Hill, told attendees at the annual meeting of the Healthcare Information and Management Systems Society.
“Social media is where our patients, customers, and consumers, as well as our colleagues are and where we need to be,” Dr. Campbell said.
He called out three specific social media tools – Twitter, Facebook Live, and blogging – as the most effective for physicians. The first two offer a key way to connect with patients and colleagues – the ability to use video.
“The most important thing out in the digital space in terms of engagement is video and the visual,” Dr. Campbell said. “You’ll get 6,000% more engagement with a video-type point of contact. That can be a link from Twitter or it can be a Facebook Live [session] or a YouTube video.”
Video messaging also helps doctors support their peers, Dr. Campbell said.
“We can provide timely information to our colleagues,” he noted. “We have Twitter chats with fellows-in-training … I can talk to fellows who are in Germany about a technique we’re using here and then they can learn more about that technique.”
Secure social media channels also can be used to share thoughts and ideas regarding a clinical query regarding a specific test or imaging result, he said.
“The patient benefits because there are more brains thinking about their problem,” he noted.
Blogging also can be effective for reaching out to patients and colleagues as it provides a way to disseminate information on topics such as new treatments or learning about disease states.
But if the blog is set up to be interactive, doctors can get insights into their patients’ health concerns, Dr. Campbell said.
“I let patients write on my blog and I actually learn a ton about the patient experience,” he said. “I don’t even think of X, Y, and Z situation. I will be more empathetic to this because of what [they] told me.”
The caveat, of course, is that specific, protected information cannot be shared or posted.
“The attorneys will really get upset,” he noted. “So you do not develop a legal duty to that patient. But you can talk about treatments and what’s out there and what’s available. ... There may be a new treatment for leukemia that’s experimental that’s coming out of a university in Philadelphia and I can talk about that treatment.”
Dr. Campbell also said social media can be effective for doctors to promote themselves, pointing to his own career where he serves as a regular commentator on both the national and local levels. Engaging with media outlets can help turn a doctor into a key opinion leader, he said.
“If you say something important, engage about important issues, patients, consumers, industry partners and other leaders in the field are going to engage with you,” he said.
Dr. Campbell reported no conflicts of interest.
ORLANDO – Looking for a better way to reach your patients and guide them to being more engaged in their own health care? Then expand your social media presence.
That was the message Kevin Campbell, MD, a cardiologist at the University of North Carolina, Chapel Hill, told attendees at the annual meeting of the Healthcare Information and Management Systems Society.
“Social media is where our patients, customers, and consumers, as well as our colleagues are and where we need to be,” Dr. Campbell said.
He called out three specific social media tools – Twitter, Facebook Live, and blogging – as the most effective for physicians. The first two offer a key way to connect with patients and colleagues – the ability to use video.
“The most important thing out in the digital space in terms of engagement is video and the visual,” Dr. Campbell said. “You’ll get 6,000% more engagement with a video-type point of contact. That can be a link from Twitter or it can be a Facebook Live [session] or a YouTube video.”
Video messaging also helps doctors support their peers, Dr. Campbell said.
“We can provide timely information to our colleagues,” he noted. “We have Twitter chats with fellows-in-training … I can talk to fellows who are in Germany about a technique we’re using here and then they can learn more about that technique.”
Secure social media channels also can be used to share thoughts and ideas regarding a clinical query regarding a specific test or imaging result, he said.
“The patient benefits because there are more brains thinking about their problem,” he noted.
Blogging also can be effective for reaching out to patients and colleagues as it provides a way to disseminate information on topics such as new treatments or learning about disease states.
But if the blog is set up to be interactive, doctors can get insights into their patients’ health concerns, Dr. Campbell said.
“I let patients write on my blog and I actually learn a ton about the patient experience,” he said. “I don’t even think of X, Y, and Z situation. I will be more empathetic to this because of what [they] told me.”
The caveat, of course, is that specific, protected information cannot be shared or posted.
“The attorneys will really get upset,” he noted. “So you do not develop a legal duty to that patient. But you can talk about treatments and what’s out there and what’s available. ... There may be a new treatment for leukemia that’s experimental that’s coming out of a university in Philadelphia and I can talk about that treatment.”
Dr. Campbell also said social media can be effective for doctors to promote themselves, pointing to his own career where he serves as a regular commentator on both the national and local levels. Engaging with media outlets can help turn a doctor into a key opinion leader, he said.
“If you say something important, engage about important issues, patients, consumers, industry partners and other leaders in the field are going to engage with you,” he said.
Dr. Campbell reported no conflicts of interest.
AT HIMSS17