OurNotes, a collaborative take on OpenNotes, has been helpful for gathering pre-visit data and driving patient engagement during COVID-era telehealth visits.
A new initiative called OurNotes is helping clinicians from Beth Israel Deaconess Medical Center (BIDMC) drive patient data access, access to clinical notes, and patient engagement in telehealth consultations, experts for the hospital detailed in a recent post in NEJM Catalyst.
The OurNotes system is built on a similar principle to the OpenNotes program. OpenNotes is neither a technology nor a vendor, but rather an organization which advocates for patients having open access to their clinical notes.
OurNotes not only enables patient access to their own medical information, but it invites patients to complete key documentation prior to a healthcare encounter and fosters clinical notetaking in tandem with a provider.
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Since the coronavirus outbreak beginning in March, clinicians at Healthcare Associates (HCA), the primary care office associated with BIDMC, have successfully transitioned to telehealth and phone-based visits, BIDMC clinicians Gila Kriegel, MD, Sigall Bell, MD, Tom Delbanco, MD, and Jan Walker, RN, MBA wrote in the Catalyst post. Delbanco and Walker are also co-founders of OpenNotes, while Bell serves as the director of Patient Safety and Discovery for OpenNotes.
The push to telehealth was intended to keep patients out of the office unless necessary, lowering the risk for coronavirus exposure for both patients and providers, but it hasn’t come without its hurdles, the authors said.
“One of the biggest challenges to clinicians was the lack of prework that previously would have been completed on site by medical assistants who measured vital signs, recorded the chief complaint, reconciled medications, and solicited requests for prescription renewals,” the authors wrote.
“Now, even absent a physical examination, clinicians quickly noted that telemedicine encounters were taking more of their time and, at times, seemed less focused than in-person visits.”
That’s when Kriegel, who has been partaking in a general pilot for OurNotes, discovered the system could be beneficial given this adjusted approach to primary care. After a patient participating in the study submitted her pre-appointment survey, Kriegel said this system could alleviate some of the new-found issues with increased telehealth use.
These pre-visit surveys, which began in February 2019 as part of the pilot project, ask patients to provide a medical history while also stating their goals for the care encounter. This information becomes a part of their medical record, creating a shared medical note between the patient and the provider.
This system not only sets an agenda for a medical encounter but it also organically prompts patients to think about their health and engage more deeply with their medical care, the leaders at OpenNotes have contended.
HCA leadership decided to adapt OurNotes for telehealth visits, inviting clinicians to outline what they’d like to see in a pre-visit survey for telehealth. Clinicians agreed it would be helpful to hear more about the medications patients were currently taking, and to receive some vitals from those with the equipment available to them.
The OpenNotes team was able to update its OurNotes patient intake survey to reflect this information.
Although the post authors were at this time unable to offer data supporting the benefits of the OurNotes approach for telemedicine, they did mention anecdotally that it has been helpful.
They also predicted they will have to adjust the program as time wears on.
“As we gain experience with the new OurNotes form, we will continue to gather feedback from participating clinicians and patients about the effectiveness of the intervention and their ideas for improvement,” they wrote. “We anticipate this will lead to iterative adjustments in the coming weeks and months, and eventually to a unified OurNotes pre-visit system that can be adopted broadly by BIDMC ambulatory care providers.”
For example, the team is still perfecting the best strategy for integrating any patient-generated health data or vitals into the EHR. They are also homing in on the best way to ask patients about their interval medical history. Should patients use free text, or should data collection be structured or semi-structured, they posited.
Nonetheless, the post authors asserted that OurNotes is a positive step forward, especially as the demands presented by the COVID-19 pandemic push medical care to greater transparency. Patient access to clinical notes may become more important than ever before, the group forecasted.
“We suspect, for example, that patients and care partners may recall even less of telemedicine encounters than they do after face-to-face office visits, and that as a result they may turn more often to reading their OpenNotes online,” they said. “Once patient- and clinician-friendly mechanisms are in place, we imagine also that inviting patients to contribute directly to their records will both support patient engagement and help clinician workflow.”
Anecdotally, many primary care providers have predicted that the shift to telehealth will be long-lasting. There is a notable convenience factor that is of benefit for both the patient and the provider, and it will be challenging to shift away from that once offices can reopen their doors.
To that end, the article authors said clinicians need to adjust their workflows and technologies, like they have with OurNotes, to ease clinician burden and improve patient engagement.
Source: Patientengagement Hit