Effect of Notes' Access and Complexity on OpenNotes' Utility

Abstract

Background: Healthcare providers are now required to provide their patients access to their consultation and progress notes. Early research of this concept, known as “OpenNotes”, showed promising results in terms of provider acceptability and patient adoption, yet objective evaluations relating to patients’ interactions with the notes are limited. Objective: To assess the effect of the complexity level of notes and number of accesses (initial read vs. continuous access) on the user’s performance, perceived usability, cognitive workload, and satisfaction with the notes. Method: We used a 2*2 mixed subjects experimental design with the two independent variables: i) note’s complexity at two levels (simple vs. complex), and ii) number of accesses to notes at two levels (initial vs. continuous). Fifty-three participants were randomly assigned to receive a simple vs. complex radiation oncology clinical note and were tested on their performance for understanding the note content after an initial read, and then with continuous access to the note. Performance was quantified by comparing each participant’s answers to the ones developed by the research team and assigning a score of 0 to 100 based on participants' understanding of the notes. Usability, cognitive workload, and satisfaction of the notes was quantified using validated tools. Results: Performance for understanding was significantly better in simple vs. complex notes with continuous access (p=0.001). Continuous access to the notes was also positively associated with satisfaction scores (p=0.03). The overall perceived usability, cognitive workload, and satisfaction scores were considered low for both simple and complex notes. Conclusion: Simplifying notes can improve understanding of notes for patients/families. However, perceived usability, cognitive workload and satisfaction with even the simplified notes were still low. To make notes more useful for patients and their families, there is a need for dramatic improvements to the overall usability and content of the notes.

Evaluating a web‐based personalized decision report for total knee or hip replacement: Lessons learned from patients

“…However, COVID‐19‐related disruptions to clinical workflows that stopped the use of paper in many clinics required changes in trial processes, with reports sent directly to patients in advance of the consultation. This change in report delivery aligns with a growing trend toward making clinical information immediately accessible to patients (e.g., OpenNotes), 40 with future immediate release of such decision reports in patient portals likely if integrated into the electronic health record. Such direct‐to‐patient dissemination requires explicit attention to support needed for independent interpretation of clinical data, including PROs.…”