A Toolkit for Implementing OpenNotes

Mar 10, 2014, 10:00 AM, Posted by Steve Downs

In writing about OpenNotes last summer, I argued that the practice of sharing clinicians’ notes with patients had moved beyond the question of whether it was a good idea (the landmark study published in Annals of Internal Medicine was pretty clear on that) to questions of how best to implement it.  As more organizations adopt the practice, it’s clear that we’re now in a phase of implementation, and experimentation with different approaches and learning.  Tom Delbanco, MD, one of the project leads, often compares open notes to a drug -- it does have some side effects and some contraindications for some people and some circumstances -- and we all need to understand those nuances.

To make it easier for health care organizations to offer the service to their patients, the OpenNotes project team has just released a new toolkit.  The toolkit focuses on two challenges:  helping organizations make the decision to implement open notes and helping organizations with all the steps involved in implementing open notes.  It includes a slide deck that lays out the results of the study and makes the case for implementation, a video profile of how a patient and her doctor have used the practice, profiles of the implementations at the pioneering sites, FAQs for clinicians and patients, and tips for clinicians on how to write open notes.  Please check it out and tell the OpenNotes team what you think:  is it valuable? How could it be better?

In a recent perspective piece in the New England Journal of Medicine, OpenNotes study leaders Jan Walker, Jon Darer, Joann Elmore and Tom Delbanco write that they anticipate that providing open notes will become the standard of care.  With institutions like Beth Israel Deaconess Medical Center, Geisinger Health System, Cleveland Clinic, Mayo Clinic, the VA Health System and several others offering open notes, they estimate that two million people now have access to the notes their physicians write about them.  The deliberations of the HIT Policy Committee are also revealing:  while the committee declined to make the provision of open notes a requirement under Meaningful Use Stage 3, their report indicates that they gave the idea serious consideration and only held back because they felt it was too early to prescribe the method for implementing open notes.  In short, there’s an increasing sense that opening up clinician notes to patients is inevitable.  It’s our hope that the new toolkit will make it easier for all who are curious about the practice to assess the idea, sell the idea, and bring it to fruition.

This commentary originally appeared on the RWJF Pioneering Ideas blog.