Boston—Cambia Health Foundation, Gordon and Betty Moore Foundation, Peterson Center on Healthcare, and the Robert Wood Johnson Foundation today jointly announced $10 million in new funding to spread access to clinical notes to 50 million patients nationwide.
OpenNotes is a national initiative that urges doctors and other clinicians to offer patients ready access to their visit notes. Neither a software program nor a new technology, experts say this change in practice represents an aggressive step in the movement toward greater transparency in health care. The results of an OpenNotes experiment involving 100 primary care doctors and 20,000 of their patients were published three years ago in the Annals of Internal Medicine. Since then, the OpenNotes movement has spread well beyond primary care to more than 5 million Americans.
Experts say ensuring access to notes written by doctors, nurses and other clinicians can prompt patients to be more active in their own health and health care, and greater patient engagement can contribute to better outcomes and reduced cost throughout the system. By dramatically expanding the scope of the OpenNotes project, the four national philanthropies funding the program are asserting that this innovation in the delivery of care, if spread nationwide, can improve the U.S. health care system’s performance.
"Our research shows increasingly that patients can benefit greatly from reading the notes taken during a medical visit. They tell us they feel more in control of their care and are more likely to follow up on recommendations,” said Jan Walker, RN, MBA, co-founder of OpenNotes and Assistant Professor of Medicine at Harvard Medical School (HMS) and Beth Israel Deaconess Medical Center (BIDMC). “This has enormous implications for improving the quality and costs of care. Moreover, we’re learning that having a second set of eyes on the record may be an important way to improve patient safety."
For the next three years, the new funding will support OpenNotes’ ability to assist providers with adoption, to reach a wide range of consumers, and to evaluate the impact of the effort on health outcomes and costs. OpenNotes will work with a broadly representative advisory board to target health care organizations and consumer advocacy groups, and also individual clinicians and consumers.
Based at Harvard Medical School and BIDMC and initially funded primarily by the Robert Wood Johnson Foundation, OpenNotes began in 2010 with a research and evaluation study examining the impact of offering clinician notes to patients at BIDMC, Harborview Medical Center and Geisinger Health System. At the end of a year, those who read their notes reported feeling more in control of their care and having better recall, knowledge and understanding of their medical conditions. Ninety-nine percent of patients wanted the practice to continue, and all participating doctors chose to keep their notes open after the study ended.
Experience suggests that giving patients access to their clinical notes holds considerable promise for addressing the stubborn challenge of improving medication adherence. More than two-thirds of patients who took medications during the original study reported improving the way they took their medications, a finding that was further validated by researchers at Geisinger Health System in a rigorous scientific study published recently in the Journal of Medical Internet Research. The investigators showed that patients being treated for high blood pressure who were offered open notes were more likely to fill their prescriptions than those without open notes.
"OpenNotes will make clinicians’ thinking far more transparent, and that holds both complex and exciting implications for patients, for their family members, and for the host of health providers who care for them. This is particularly true for vulnerable populations and patients with a large burden of chronic illness, including mental illness,” said Tom Delbanco, MD, co-founder of OpenNotes, a primary care doctor at BIDMC, and the Koplow–Tullis Professor of General Medicine and Primary Care at HMS. “Opening the doctor’s black box breaks down traditional barriers and provides a foundation for all kinds of exciting innovations in health care, changes that in my view will benefit the vast majority of patients and their clinicians."
In the three years since the pilot results were reported, the OpenNotes movement has continued to spread—including widespread adoption by major medical systems nationwide and within geographic regions, such as Oregon and southwest Washington.
"We’re thrilled to be supported by these prestigious foundations,” said Delbanco. “Our expanding team now has a remarkable opportunity to move OpenNotes from a longstanding promising idea toward a new national standard of medical care."
Statements from Funders
"OpenNotes aligns with Cambia Health Foundation’s mission to make the health care system more person-focused, and proves the power of funders coming together to support a game-changing movement in which patients can instantly become active participants in all aspects of their health care delivery." —Steven Lesky, Cambia Health Foundation
"OpenNotes is a remarkably simple way to substantially improve health care by fueling transparency and communication. We view this as a ‘must-have’ tool for everyone and why the Gordon and Betty Moore Foundation and its foundation partners have come together to spread OpenNotes to reach as many patients as possible, to enable better health care experiences and outcomes." —Dominick Frosch, PhD, Gordon and Betty Moore Foundation
"Health outcomes, cost of care, patient experience and clinician satisfaction are all important indicators of whether the healthcare system is performing well, and we believe that OpenNotes can improve the system on all those measures. Learning how OpenNotes spreads to 50 million patients will also help as we seek to spread and scale other innovations that improve the system along these measures." —Jeffrey Selberg, Peterson Center on Healthcare
"The Robert Wood Johnson Foundation has proudly funded OpenNotes since 2010, when the first pilot was conducted. Engaged patients who have strong relationships with their clinicians are critical to building a nationwide Culture of Health. We are pleased to continue to share this innovative approach.” —Susan Mende, Robert Wood Johnson Foundation
OpenNotes is a national movement that invites patients, families and clinicians to come together and improve communication through shared clinicians’ notes and fully transparent medical records. To learn more, visit www.opennotes.org.
About Cambia Health Foundation
Cambia Health Foundation is the corporate foundation of Cambia Health Solutions, a total health solutions company dedicated to transforming the way people experience the health care system. A 501(c)(3) grant-making organization, the Foundation invests and partners with organizations to advance palliative care quality, access and understanding; improve the behavioral health of underserved children; and transform health care to a more person-focused and economically sustainable system. Learn more at cambiahealthfoundation.organd follow us on Twitter.
About the Gordon and Betty Moore Foundation
Gordon and Betty Moore Foundation fosters path-breaking scientific discovery, environmental conservation, patient care improvements and preservation of the special character of the Bay Area. Visit www.moore.org or follow @MooreFound.
About the Peterson Center on Healthcare
The Peterson Center on Healthcare is a non-profit organization dedicated to making higher quality, more affordable healthcare a reality for all Americans. The organization works to transform U.S. healthcare into a high-performance system by finding innovative solutions that improve quality and lower costs, and accelerating their adoption on a national scale. Established by the Peter G. Peterson Foundation, the organization collaborates with stakeholders across the healthcare system and engages in grant-making, partnerships and research. For more information about the Peterson Center on Healthcare visit www.petersonhealthcare.org.
About the Robert Wood Johnson Foundation
For more than 40 years the Robert Wood Johnson Foundation has worked to improve health and health care. We are striving to build a national Culture of Health that will enable all to live longer, healthier lives now and for generations to come. For more information, visit www.rwjf.org. Follow the Foundation on Twitter at www.rwjf.org/twitter or on Facebook at www.rwjf.org/facebook.