The Value of Providers' Notes: Patient Engagement Through Electronic Platforms

Researchers at the Beth Israel Deaconess Medical Center in Boston investigated the impact of patient engagement in evaluating their care visit notes and found patients and care partners who chose to provide feedback were enthusiastic about assisting with improving the accuracy of clinician notes.

Healthcare systems are increasingly providing patients access to online portals as well as patient electronic health records (EHRs). There remains, however, a dearth of information on patient experience with reading and using this health information.

To gather the data, the researchers—in tandem with patients and their family members, Patient Relations and Health Information Management personnel, Patient Safety leadership, clinicians, and other stakeholders—developed an online OpenNotes patient reporting tool aimed at improving care quality. Following a 9-month period of development, a 9-item form accessible through a “My Feedback” link at the end of each visit note was created, which was accessible to patients only after reading the visit notes. Questions included whether patients or care providers:

• Understood the note and care plan
• Identified possible inaccuracies in the note
• Had positive feedback for their providers
• Found the reporting tool valuable

Patients who reported that they found the opportunity to read and provide feedback on their notes valuable, were further probed with a more subjective question: “What do you like about reading or providing feedback on your note?”

“When experts talk about the power of health information technology, we often hear about efforts to make care more patient- and family-centered, but we've heard very little about what matters to the patients themselves, perhaps because information sharing has been largely one-way and passive,” said first-author Macda Gerard.

During the 12-month pilot, launched within 2 of 10 teams in their hospital’s primary care practice, the reporting tool was used by 260 patients and caregivers. Nearly all the reports (98.5%, 256/260) indicated that the reporting tool was valuable, and 68.8% (179/260) provided feedback on what patients liked about reading notes and the reporting process itself.

“When we asked patients what they liked about gaining access to the content of their notes, four themes emerged,” Gerard said explaining their findings. “Patients appreciated the ability to confirm and remember next steps and welcomed quicker access to results. They reported that reading the notes helped them feel heard and gain confidence in their providers, and they valued the opportunity to share information with care partners.”

Additionally, the authors identified 4 themes around patient use of notes and the feedback tool:

• Accuracy and correcting mistakes
• Partnership and engagement
• Bidirectional communication
• Importance of feedback

The results of this study have encouraged the authors to conduct follow-up studies to ensure continued patient and caregiver engagement.

“Future efforts to engage patients through the EHR may be guided by what patients value, offering opportunities to strengthen care partnerships between patients and clinicians,” they concluded.

The study was published in the Journal of Medical Internet Research.