Grant will help BIDMC develop patient-contributed EHR

Beth Israel Deaconess Medical Center (BIDMC) in Boston has received a $450,000 grant from The Commonwealth Fund to develop OurNotes, an initiative to promote active patient engagement in health and illness that invites patients to contribute to their own electronic medical records.

"We know that increasing patient engagement is a critical component of improving healthcare, and we hope to build on BIDMC's well-established work in this area," said Anne-Marie Audet, MD, vice president at The Commonwealth Fund, in a release. "This research will explore the potential for OurNotes to help improve care among the most medically complex patients-–those with multiple chronic health conditions."

"This is really building for the future. We envision the potential capability of OurNotes to range from allowing patients to, for example, add a list of topics or questions they'd like to cover during an upcoming visit, creating efficiency in that visit, to inviting patient to review and sign off on notes after a visit as way to ensure that patients and clinicians are on the same page," said principal investigator, Jan Walker, RN, MBA, Division of General Medicine and Primary Care at BIDMC and assistant professor of medicine at Harvard Medical School.

OurNotes is an extension of OpenNotes, a movement to offer patients ready, online access to their clinicians' visit notes. More than 5 million patients across the U.S. are now using OpenNotes.

"Our research has shown--and feedback from patients continues to confirm--that patients benefit from reading their visit notes. For example, patients say they have better recall of the treatment plan, feel more in control of their healthcare and report improved adherence to medications," said Walker. "We believe that OurNotes, which will enable patients to contribute to their own medical records, has the potential to further enhance communication and engage patients in managing illness more effectively and efficiently, leading to improved patient safety and quality of care and potentially, to lower healthcare costs."

The Commonwealth Fund grant will support work at five sites, including original OpenNotes study partners, BIDMC, Geisinger Health System in Danville, Pa., and Harborview Medical Center in Seattle, Wash., and more recent OpenNotes adopters, Group Health Cooperative, also in Seattle and Mosaic Life Care in St. Joseph, Mo.

The multi-center team will work with industry experts, clinicians and patients on a user-centered design process, focusing initially on primary care. "During this phase we'll be asking clinicians questions about what kinds of information they think would be helpful to receive from patients. Likewise, we'll be talking to patients to find out what kinds of information they would like to contribute to their records and their notes," said Walker.

Findings from this initial phase of work will be used to develop prototypes at each site and to conduct pilot testing that, in turn, will lead quickly toward formal clinical trials.

"We envision OurNotes as a therapeutic intervention that will prove effective over time for a wide range of patients, especially those struggling with chronic health concerns," said co-investigator Jonathan Darer, MD MPH, chief innovation officer at Geisinger Health System. "We expect this process to enlighten our understanding of patient and family engagement and its role in reducing healthcare costs, increased shared accountability, improving the health of those with chronic illness and multiple comorbidities and, most importantly, enhancing the overall patient experience of care."