Transcript Document

Partnering with Patients for Safety:
The OpenNotes Patient Reporting Tool
The Problem
Asked what they liked or learned from notes, patients
and caregivers commented:
Results/Progress to Date
Safety experts struggle with effective ways to
reduce error in ambulatory care. OpenNotes, an
innovation that invites patients to review their
clinicians’ notes online may be a means for
patients to report possible errors in their notes.
 105 reports were submitted from August-- December 2014
 95% were from the patients, 5% from informal caregivers
“It’s a great way to
double check I didn’t
miss anything if I was
not feeling well or was
too overwhelmed.”
Reports Submitted from August-December 2014
Aim/Goal
To conduct a pilot study to measure the
Identified "Potential Safety
effectiveness the OpenNotes Reporting Tool to
Concerns"
solicit positive patient feedback and reports of
possible errors in notes.
Volunteered positive feedback
about providers/notes
22%
“I like knowing what the
results of my tests mean. The
records shows the numbers,
but the notes provides the
interpretation”
71%
The Team
Sigall Bell
Roanne Mejilla
Mary Barry
Tom Delbanco
Beth French
Macda Gerard
Amy Goldman
Heidi Jay
Susan Johnson
Gila Kriegel
Julia Lindenberg
Larry Markson
Elena Premack Sandler
Ken Sands
Jan Walker
Gail Wood
Pat Folcarelli
Thought note accurately
reflected visit
95%
Understood the note
95%
Found the tool "very valuable"
and would use it again
The Intervention
 We invited 2 of 10 practice teams in
HealthCare Associates to participate in this
pilot program
 A link at the end of the clinician note led to
10 item survey with both quantitative and
qualitative questions.
 “Potential Safety Concern” was defined as
either not understanding the plan of care or
reporting a possible inaccuracy in the note
Patient Reads Note and at the end of the note is
invited to give feedback in safety reporting tool
Patient Relations reviews all responses
Safety Concern?
Yes
Patient Relations reaches out to patient
and/or clinician to discuss concern and
then loop with patient is closed
87%
0%
20%
No
Aggregate data on survey
feedback is captured in
database for study
40%
60%
80%
100%
9%
30%
17%
22%
“I appreciate the
opportunity to
praise my
healthcare
providers.”
Lessons Learned
Past medical history
Family history
Next Steps
Physical Exam (including part of
exam documented but not done)
 Continue current pilot with a goal of 200
respondents
 Explore opportunities to expand reporting tool in
ambulatory practices
22% Identified “Potential Safety Concerns” including:
10%
“Health care should
be a two-way
conversation; this
forum provides
another opportunity
for that.”
 Great majority of participants reported understanding
notes.
 Patients/caregivers reported possible inaccuracies in
about one-quarter of reports, resulting in a change in
the record or care in the majority of cases.
 For every error or near miss caught, there may be
false alarms, and shielding busy clinicians from an
uptick in calls will be critical to sustainability
 An online patient reporting tool linked to open notes
can help engage patients as safety partners, support
providers with positive feedback, and inform
organizations of improvement opportunities.
Percentage of respondents
13%
HCA visit Triggers Note
“I appreciate the open
exchange and the
opportunity to correct
any possible
misunderstandings.”
98%
Understood the plan of care
“…especially helpful for
older patients who may
have hearing and/or
some cognitive/memory
loss.”
Possible inaccuracies in
medications
Something important missing
from note
Report of symptoms
 Majority of reports led to a change in the record or in care
 Extrapolating to 10 teams, these data predict over 1200 reports
and almost 300 otherwise unidentified risks annually, reflecting a
nearly 50% increase in ambulatory reporting through our
hospital’s online event report system.
For more information, contact:
Sigall Bell, MD: [email protected]