Who Is Sharing Notes?
At the University of Texas MD Anderson Cancer Center, patients and their referring physicians have been given access to their electronic medical records—including their doctors’ notes—since May 2009 via a secure Web-based portal.
Despite little promotion of the site to patients, to date more than 40,000 individuals have viewed their records over 605,000 times. In that same period, more than 1300 referring physicians accessed the records of the patients they referred to us over 28,000 times. Currently, 84% of our active patients have obtained access to their electronic records.
Patients have become avid readers of their notes—their 2 most common requests are for a correction of something recorded incorrectly and for a simple method of translating medical terminology within the record. Our referring physicians are happy with the tool, and we are planning to cease mailing records to referring physicians.
Beth Israel Deaconess Medical Center (BIDMC) in Boston, MA, is an academic medical center affiliated with Harvard Medical School. It employs approximately 2,400 clinical staff, including 800 physicians and 1,200 registered nurses. BIDMC has 649 inpatient beds, and offers both hospital- and community-based ambulatory care. BIDMC developed its EMR beginning in the 1980s and opened its patient portal, PatientSite, in 1999. Approximately 75,000 patients have PatientSite accounts.
BIDMC first opened notes to patients of 39 volunteering primary care physicians in 2010, as part of the initial OpenNotes demonstration project. On review of the study’s results, the hospital’s Clinical Operations Executive Committee voted to open all clinicians’ notes.
Geisinger Health System is an integrated health services organization widely recognized for its innovative use of the electronic health record, and the development of innovative care models such as ProvenHealth Navigator® and ProvenCare®. As the nation’s largest rural health services organization, Geisinger serves more than 2.6 million residents throughout 44 counties in central and northeastern Pennsylvania. The physician-led system is comprised of more than 19,500 employees, including a 1,000-member multi-specialty group practice, six hospital campuses, two research centers and a 448,000-member health plan, all of which leverage an estimated $6.1 billion positive impact on the Pennsylvania economy. The health system and the health plan have repeatedly garnered national accolades for integration, quality and service. In addition to fulfilling its patient care mission, Geisinger has a long-standing commitment to medical education, research and community service. For more information, visit www.geisinger.org, or follow the latest Geisinger news and more on Twitter and Facebook.
Harborview Medical Center (HMC), managed by the University of Washington in Seattle, began using electronic health records in 1995. Since 2010, HMC has allowed online access to electronic health records for select patients in its HIV clinic and an adult medicine clinic using a patient portal as part of the OpenNotes study. In addition to their primary care visit notes, these patients can view laboratory, cardiology, radiology and pathology results. Many of HMCs patients are without regular access to computers at home and use public spaces, such as libraries, to access the Internet.
The hospital’s mission is to serve a broad population, including medically underserved patients, uninsured and underinsured populations, and homeless and incarcerated patients. Many patients have complicated medical conditions that co-exist with substance abuse or psychiatric illness.
The Department of Veterans Affairs (VA) is home to the United States’ largest integrated health care system, with over 1,700 sites of care serving 8.3 million Veterans each year. The VA is committed to transparency and patient-centered care by enhancing information and services available to Veterans online. The prototype of VA’s personal health record, the My HealtheVet Pilot, provided over 7,000 VA patients in nine facilities full access to their health record information. In 2003, My HealtheVet was launched nationwide and has continuously enhanced its capabilities. Offering medication refill, secure messaging, tailored wellness reminders and other services and information, My HealtheVet now boasts more than 2.2 million registrants.
In 2010, VA introduced the Blue Button, allowing Veterans to view, print, or save their personal health information. Users can download a file to a location of their choosing. Since January 2013, Veterans with a Premium Account have access to clinical notes in their VA Electronic Health Record, including outpatient primary care and specialty visit notes, discharge summaries and emergency department visit notes. In addition to access to test and imaging results, users can also view and download the VA Continuity of Care Document (VA CCD), a summary of important health information from the Veterans VA Electronic Health Record. The VA CCD is a standard electronic exchange document used for sharing patient information.
On Nov. 1 2013, Columbia St. Mary’s Health System in Milwaukee became the first hospital in Wisconsin to implement OpenNotes. Over 1,100 multi-specialty doctors, nurse practitioners, and others who write visit notes, will be sharing them with more than 300,000 patients via a secure online portal. Columbia St. Mary’s is part of Ascension Health, the largest nonprofit Catholic health system in the country. This month, it also becomes the first hospital system to share hospital discharge summaries with patients.
Columbia St. Mary’s comprises four hospitals, Columbia St. Mary’s Hospital Milwaukee (including the Women’s Hospital), Columbia St. Mary’s Hospital Ozaukee, Sacred Heart Rehabilitation Institute and a partnership with the Orthopaedic Hospital of Wisconsin. In addition, there are 62 primary care clinics, the Columbia College of Nursing, and an affiliation with Madison Medical Affiliates. The system serves Milwaukee, Ozaukee, Washington and Sheboygan counties, with more than 164 years of service.
Columbia St. Mary’s and its sponsor organizations, Ascension Health and Columbia Health System, share a mission to make a positive difference in the health status and lives of individuals in the community with a special concern for those who are vulnerable. For more information, visit www.columbia-stmarys.org.
Penn State Hershey Medical Group comprises 63 outpatient clinics and more than 900 clinicians offering a full range of primary care and specialty health services to the residents of central Pennsylvania. It is affiliated with Penn State Hershey Medical Center, a leading academic medical center located in Hershey, Pa. Its campus includes Penn State College of Medicine (Penn State’s medical school), Penn State Hershey Cancer Institute, and Penn State Hershey Children’s Hospital.
On October 1st, 2013, Penn State Hershey Medical Group, using the OpenNotes model and its resources, rolled out the following initiative across the outpatient clinical enterprise. The Medical Group began offering patients access to outpatient clinician notes, letters, lab and imaging through the My Penn State Hershey Health portal. Penn State Hershey Medical Center is dedicated to providing high-level, patient-focused medical care for the people of central Pennsylvania and beyond. An important component of that care is expanding patient engagement and the OpenNotes initiative fosters that goal. For more information, visit, http://www.pennstatehershey.org/
WellSpan Health is an integrated health system that serves the communities of central Pennsylvania and northern Maryland. The organization is comprised of a multispecialty medical group of more than 660 providers, a home care organization, four respected hospitals, more than 11,000 employees, and 93 patient care locations. WellSpan is consistently recognized by SDI as one of the Top 100 Integrated Health Networks in the United States and has been recognized by Health Imaging and IT as one of the nation’s “Top 25 Connected Healthcare Facilities.”
WellSpan fully supports the movement to help patients access and securely share their own health information. WellSpan has been providing patients with access to lab results, physical, allergy, medication and immunization data for several years. In 2013, access to imaging studies was added. In pursuit of completely transparent electronic health record, WellSpan began offering patients access to office visit notes in March 2014.
Beginning on April 8, 2014, Kaiser Permanente Northwest provides nearly 500,000 members with online access to the notes written by their clinicians. The notes will be available following most primary and specialty care office visits or scheduled telephone visits.* Members who are registered users of kp.org will receive an email (typically within 48 hours following their visit) indicating they have a visit note available to view. Once they log on to “My health manager,” they will see the office visit or scheduled telephone visit listed on the “Past visit information” tab in their record. The note will be available as part of the “After Visit Summary” that appears when they click on the link for the date of the visit.
The Kaiser Permanente Northwest physician leads on the OpenNotes initiative are Michael McNamara, MD, chief medical information officer, and Robert Unitan, MD, director of optimization and innovation. The Northwest is the first region within Kaiser Permanente to implement OpenNotes, with other regions likely to follow.
*Initially, clinician notes will not be available for inpatient stays, Emergency Department visits, and for patients of addiction medicine, employee health services, mental health, occupational health, pain clinic or pediatric patients between 13 and 17.
Legacy Medical Group, Legacy Health’s provider group, delivers care in the Portland Metropolitan area and Southwest Washington. More than 85,000 patients receive their care from the 400 primary care and specialty physicians of the Legacy Medical Group. Legacy Health will begin offering open notes April 12, 2014 to selected physicians and groups of physicians. Melinda Muller, MD, VP of Primary Care, and Amy Chaumeton, MD, the Chief Medical Informatics Officer, will be managing the implementation.
OCHIN is one of our nation’s largest health information networks, spanning 18 states, 78 clinic system members and more than 4,500 physicians. Its Health IT solutions improve the integration and delivery of healthcare services across a wide variety of practices—with an emphasis on safety net clinics and small practices as well as critical access and rural hospitals. OCHIN recently made it possible for all 4,500 physicians to use OpenNotes. Two Oregon OHSU Family Medicine clinics in Scappoose and Portland are already using OpenNotes, and Tim Burdick, MD, OCHIN’s Chief Medical Informatics Officer, expects that other OCHIN clinic members will be starting up soon. Visit www.ochin.org.
Oregon Health & Science University has begun offering open notes to selected individual physicians and small groups of physicians. By mid-May of 2014 the four family practice clinics at OHSU will implement open notes. More than 2000 physicians practice at OHSU sites, taking care of more than 1 million patients. Tom Yackel MD is the Chief Health Information Officer at OHSU and managing the implementation of open notes.
The Portland Clinic is an independent multispecialty practice with clinics throughout the Portland metro area. The Portland Clinic provides primary care for over 70,000 patients and offers a wide range of specialists who have patients referred from physicians throughout the region. Chief Information Officer John Sanders PhD has been working with Ron Naito MD and other TPC physician leaders on the OpenNotes initiative. The Portland Clinic is completing development and testing, and expects to go live with open notes during the summer of 2014.
The Providence Medical Group of Oregon provides care throughout the state—Portland, the Oregon Coast, Medford, and in the Columbia Gorge. More than 115,000 patients receive their care at Providence Medical Group from 620 MD clinicians. Providence leadership has decided to implement open notes, likely in 2015 as they implement additional enhancement in their record system. Daniel Rosenberg MD is the Providence Medical Director physician champion managing and coordinating the open notes implementation.
Salem Health is comprised of Salem Hospital, West Valley Hospital, Willamette Health Partners, and other services offering care to Oregon’s mid-Willamette Valley. In 2013, Salem Hospital and West Valley Hospital admitted approximately 21,000 patients and saw 123,000 visits in the emergency department and convenient care. There are 649 practitioners on the active medical staff. Salem Health plans to implement a test phase of open notes in its family medicine department by May 2014. Shea Corum, Informatics Director at Salem Health, is managing the implementation-testing phase. If proven successful, open notes will become available to over 12,000 patients.
The Vancouver Clinic is a private multispecialty group practice in Vancouver, caring for over 150,000 patients in southwest Washington and Oregon. The Clinic plans to offer open notes to their patients in 2014 as they complete work related to their electronic medical record. Marcia Sparling MD, Medical Director for Operations and IT, is leading the OpenNotes Project implementation.
Nationwide Children’s Hospital became the first children’s hospital in the U.S. to offer OpenNotes access to its Primary Care Network patients earlier this month as part of the hospital’s MyChart patient portal. OpenNotes provides access to healthcare provider notes from each patient encounter. Initially focusing on patients from birth through 12 years of age, patients and their families are educated about OpenNotes at each appointment and college students will be available in each Primary Care Center this summer to encourage patients and families to access OpenNotes and walk them through the access process.
Through its Primary Care Network, Nationwide Children’s offers community-based physician services at 12 centers for children ages birth to 21 year of age to keep pediatric patients healthy with regular physical exams, vision, hearing and general devleopment checks, and childhood diseases immunizations. The Nationwide Children’s Primary Care Network is one of the largest hospital-owned pediatric primary care networks in the U.S. and has received recognition as a Patient Centered Medical Home by the National Committee for Quality Assurance (NCQA). The NCQA Patient Centered Medical Home standards emphasize the use of systematic, patient-centered, coordinated care that supports access, communication and patient involvement.
Ranked in all 10 specialties on U.S.News & World Report’s 2013-14 “America’s Best Children’s Hospitals” list, Nationwide Children’s Hospital is one of the nation’s largest not-for-profit freestanding pediatric healthcare networks providing wellness, preventive, diagnostic, treatment and rehabilitative care for infants, children and adolescents, as well as adult patients with congenital disease. Nationwide Children’s, also ranked among the Top 10 on Parents magazine’s 2013 “Best Children’s Hospitals” list, has a medical staff of 1,100 and 9,400 employees that provide state-of-the-art pediatric care for one million patient visits annually. Nationwide Children’s remains true to the original mission since its founding in 1892 of providing care regardless of a family’s ability to pay. More information is available at NationwideChildrens.org.