The OpenNotes initiative, initially funded by the Robert Wood Johnson Foundation, began in 2010 with the premise that allowing patients to view their progress notes would increase patient engagement and improve care. Their research demonstrates that patients that view their notes feel more in control of the care and are more likely to follow medication instruction.

While the majority of studies have looked at release of primary care visit notes, neurologists may be interested in implementing note release in their outpatient practices. Opening the chart to the patient can be considered in the same manner as any other medical intervention, with specific benefits and risks. This toolkit provides general and specialty-specific considerations for implementing note release.

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Can You Share Notes?

Many of the larger electronic health record (EHR) programs have this functionality built in; small EHR programs may not. Check with your vendor if you are unsure about the capability in your EHR.

Who Will Share Notes, and What Will Be Shared?

Notes are often shared with patients via patient portals and release of notes typically begins from the start date and old notes are not released. Prior to sharing notes, many things should be considered.

Additional ConsiderationS

Consider the special circumstances that exist with regards to resident notes. Consider releasing the note only once cosigned by the attending physician.

Consider the types of information to be shared:

  • Progress notes
  • Telephone calls
  • Nursing notes
  • Notes written by nurse practitioners, physician assistants and ancillary staff

Learn about additional considerations.

 

How Will Providers Be Informed?

Education is key at this stage.

  • As with any new intervention, some providers will be reluctant to allow patient access. They may fear an increased workload due to patient questions regarding the note. Initial studies did not show an increase in time spent with patients or answering questions after the visit.
  • Providers may need guidance to adjust their documentation style to one that's more "patient friendly."
  • Remind providers that patients can already access their progress notes via a signed release of information request.
  • Consider counseling providers to hold initial consultation reports from release if sensitive diagnoses (e.g., Huntington's disease, conversion disorder) are being considered and have not been discussed with the patient.
  • Develop FAQs to address provider concerns.

 

How Will Patients Be Informed Notes Are Available?

"Big Bang" Roll Out 

Consider wide notification of patients, with clinic posters, brochures, patient messages, advertisements.

"Quiet" Roll Out

Patients could receive individual notification after their visit is complete via portal message or on their After Visit Summary.

Consider sending patient reminders that a note is available for viewing after a visit is complete.

 

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