Pilot sites to test concept of patients contributing to clinical notes

Four healthcare organizations have agreed to serve as pilot sites for OurNotes, an initiative aimed at encouraging patients and providers to jointly create clinical notes and care plans within a shared electronic health record.

Beth Israel Deaconess Medical Center, Dartmouth-Hitchcock Medical Center, the University of Colorado and the University of Washington will be piloting OurNotes starting in the spring, with a focus on engaging patients who have chronic conditions.

Matthew Germak, MD, with the OurNotes team at Beth Israel Deaconess Medical Center, says that in addition to being one of the four pilot sites BIDMC—which has its own homegrown EHR—is helping to coordinate and standardize efforts with the other three sites, all of which are using Epic systems.

“What we will be piloting next year is patients contributing information prior to their primary care clinicians office visits via their organizations’ patient portals—so, all of this will be an electronic exchange,” adds Germak, who is a primary care physician. “The vision is to have that information get integrated into their doctors’ notes so that we promote more active patient engagement.”

According to Germak, patients participating in the pilot will receive an electronic form through their respective portals before their office next and input the following information: interval history (how they have been doing since their last doctor visit), medication reconciliation, the agenda for upcoming physician visit and a review of notes of their prior visits.

Funded by The Commonwealth Fund, OurNotes is an extension of the nationwide OpenNotes movement in which physicians share EHR notes with their patients. Currently, more than 20 million patients across the country have electronic access and can read their clinicians’ notes.

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Germak describes OurNotes as a “continuation of the same spirit” as OpenNotes. However, he observes that OpenNotes “provides what one could argue is relatively passive patient engagement, but it really doesn’t allow active participation beyond that in terms of inputting data into the actual medical record and notes.”

That’s where OurNotes comes into play, according to Germak, “where we could provide a platform for patients, family members and informal caregivers to more actively contribute to their medical record and to their healthcare by providing information that’s directly integrated” into the EHR.

A study published last month in the Annals of Internal Medicine, based on telephone interviews with 29 healthcare experts to vet the concept, found that stakeholders see OurNotes as a potential benefit for patient engagement, patient-centered care, patient-physician collaboration, as well as reducing the documentation burden on providers.

“Doctors are totally overwhelmed and burning out at record high rates all across the country, especially primary care physicians—they’re really overstretched,” says lead author John Mafi, MD, assistant professor of medicine in the division of general internal medicine and health services research at the David Geffen School of Medicine at UCLA. “The idea of having patients doing some of the documentation and getting their voices heard could be a win-win for everybody concerned.”

“The devil’s in the details, and that’s why it’s really important to watch these pilot studies very carefully,” Mafi adds. “We’ll have to see what the pilot studies show.”

“We’re excited to put this to the test—it’s hope, aspiration and vision mostly at this point,” concludes Germak, who says the pilot will run for a year and wrap up in the spring of 2019. “This is somewhat of a new frontier.”