Evaluating the Impact of Patients' Online Access to Doctors' Visit Notes

Designing and Executing the OpenNotes Project

In this study, the authors conducted a one-year, multi-site trial of patient-accessible online office visit notes system OpenNotes, and found that many primary care physicians (PCPs) were willing to participate.

This study involved interventions in the health care systems of Boston, Pennsylvania and Seattle, where PCPs in each site were invited to participate in offering OpenNotes to their patients. With the intervention, patients were given access to their PCP's notes for one year. Boston and Pennsylvania had preexisting patient Internet portals, while Seattle used an experimental portal. PCPs who declined participation, and their patients, made up the comparison group. The authors used interviews and focus groups with doctors and patients to develop pre- and post-intervention surveys, and tracked uses of Internet portals before and during the intervention.

A total of 114 PCPs participated in the intervention, along with 22,000 patients who were registered portal users. PCP participation rates varied across the three sites: 19 percent in Pennsylvania; 66 percent in Boston; and 87 percent in Seattle.

Many PCPs were willing to participate in this year-long, potentially disruptive study, indicating the feasibility of conducting large-scale, multisite studies of interventions involving online portals to electronic health records. Results of such studies will inform providers, policy-makers and patients as they consider changes to patient engagement in health care.