Patients Contributing to Visit Notes: Mixed Methods Evaluation of OurNotes

Abstract

Background Secure patient portals are widely available, and patients use them to view their electronic health records, including their clinical notes. We conducted experiments asking them to cogenerate notes with their clinicians, an intervention called OurNotes. Objective This study aims to assess patient and provider experiences and attitudes after 12 months of a pilot intervention. Methods Before scheduled primary care visits, patients were asked to submit a word-constrained, unstructured interval history and an agenda for what they would like to discuss at the visit. Using site-specific methods, their providers were invited to incorporate the submissions into notes documenting the visits. Sites served urban, suburban, and rural patients in primary care practices in 4 academic health centers in Boston (Massachusetts), Lebanon (New Hampshire), Denver (Colorado), and Seattle (Washington). Each practice offered electronic access to visit notes (open notes) to its patients for several years. A mixed methods evaluation used tracking data and electronic survey responses from patients and clinicians. Participants were 174 providers and 1962 patients who submitted at least 1 previsit form. We asked providers about the usefulness of the submissions, effects on workflow, and ideas for the future. We asked patients about difficulties and benefits of providing the requested information and ideas for future improvements. Results Forms were submitted before 9.15% (5365/58,652) eligible visits, and 43.7% (76/174) providers and 26.76% (525/1962) patients responded to the postintervention evaluation surveys; 74 providers and 321 patients remembered receiving and completing the forms and answered the survey questions. Most clinicians thought interim patient histories (69/74, 93%) and patient agendas (72/74, 97%) as good ideas, 70% (52/74) usually or always incorporated them into visit notes, 54% (40/74) reported no change in visit length, and 35% (26/74) thought they saved time. Their most common suggestions related to improving notifications when patient forms were received, making it easier to find the form and insert it into the note, and educating patients about how best to prepare their submissions. Patient respondents were generally well educated, most found the history (259/321, 80.7%) and agenda (286/321, 89.1%) questions not difficult to answer; more than 92.2% (296/321) thought sending answers before the visit a good idea; 68.8% (221/321) thought the questions helped them prepare for the visit. Common suggestions by patients included learning to write better answers and wanting to know that their submissions were read by their clinicians. At the end of the pilot, all participating providers chose to continue the OurNotes previsit form, and sites considered expanding the intervention to more clinicians and adapting it for telemedicine visits. Conclusions OurNotes interests patients, and providers experience it as a positive intervention. Participation by patients, care partners, clinicians, and electronic health record experts will facilitate further development.

Extracting Medical Information From Free-Text and Unstructured Patient-Generated Health Data Using Natural Language Processing Methods: Feasibility Study With Real-world Data

“…This study extends the existing literature [ 15 ], presenting the capability of current models to extract key information from patient notes. This approach can inform patients and caregivers out of the clinic toward enabling self-care (eg, improving medical adherence, symptom tracking) and remote monitoring (eg, detection, intervention, and communication) [ 11 ]. In clinical practice, the use of such artificial intelligence and machine learning approaches potentially facilitates the inclusion of personal health records into medical records, which can allow the identification of health condition changes and build early detection mechanisms [ 3 , 32 ].…”

“…Given the limited time and ability to read and communicate patient notes, this information could be underused and create an additional burden [ 10 ]. Integrating PGHD into electronic health record systems is an acknowledged contribution, as it can create a more comprehensive view of health conditions and eventually inform shared decision-making [ 11 ]. Yet, free-text patient notes or unstructured PGHD integration requires further considerations on clinical workflow and clinical burden [ 3 ].…”

The Voice of the Patient and the Electronic Health Record

“…18 The OurNotes concept is fairly new and not yet broadly adopted, but offers the opportunity to capture the patient's perceptions including improvement or worsening of symptoms, changes in health, treatment effects, and quality of life. 19 However, the patient portal offers many opportunities to engage the patient and explore his/her preferences. We could develop asynchronous tools to solicit patient information such as satisfaction with life and health status after an intervention or a new prescription, health concerns and their priorities prior to a visit, or goals for their health and wellbeing.…”

The Deep Work of Doctoring—Prioritizing Relationships in Medicine

“…Encourage patient involvement through shared decision-making, shared clinic notes (OpenNotes), patient contribution to chart (OurNotes)…”

“…5,6,8 Face-to-face communication also strengthens colleague relationships, including shared problemsolving. Patients, too, are beginning to set up notes and agendas through the OurNotes initiative, 3 decreasing documentation time, encouraging engagement, and contributing to solutions.…”