OpenNotes Expands Regional EHR Adoption

Kaiser Permanente Northwest is one of several healthcare providers participating in an effort to roll out open access to clinician notes as a standard of care throughout the Pacific Northwest.

A consortium of nine healthcare provider systems is targeting more than one million residents of Oregon and southwest Washington State in 2014 to provide open access to their physicians' notes in electronic medical records.

The announcement this week marks the first time that OpenNotes, a national movement that urges health-related organizations to adopt open access to clinician notes as a standard of care, has been embraced simultaneously throughout an entire region.  

Spurred by the efforts of the nonprofit, nonpartisan health advocacy organization, We Can Do Better, the healthcare providers that have committed to practicing open notes, are Kaiser Permanente Northwest, Legacy Health, Oregon Health & Science University, Providence Medical Group Oregon, The Portland Clinic, The Vancouver Clinic, Portland VA Medical Center, OCHIN and Salem Health.

Each of these groups is already practicing open notes in some form or intends to do so sometime in 2014 or 2015, the group says.

Kaiser Permanente Northwest was scheduled to begin making clinician notes available to its members across the region Tuesday. "Now, nearly 500,000 Kaiser Permanente members will, for the first time ever, be able to easily view the notes charted by their doctor during an office visit," said Michael McNamara, MD, chief medical information officer for Kaiser Permanente Northwest in a statement. "We want patients to feel connected with their providers, and to have the type of tools that will enable them to be more engaged and in control of their care."

Legacy Health will launch its participation on April 12 starting with specific practices, and eventually reaching 85,000 patients, a spokesman said.

OpenNotes was first piloted as part of large-scale research study conducted at Boston's Beth Israel Deaconess Medical Center, Geisinger Health System in Pennsylvania, and Harborview Medical Center in Seattle. All have adopted it. Since January 2013, the U.S. Department of Veterans Affairs, including the Portland VA Medical Center, have also adopted full transparency of clinical note access.

While federal law mandates a patient's right to access their medical records, including clinician notes, obtaining copies of paper records can be time-consuming and in some cases, involve costs for the patient.

"Oregon and Southwest Washington represent the first region in the US to collaborate on implementing open notes as a community," said Amy Fellows, Director of We Can Do Better in a statement. "Local health providers have been very supportive of providing patients here in the Northwest with this increased level of transparency. We look forward to the day when all consumers will be able to access their providers' notes."

The use of open notes by groups in the Northwest extends beyond the region. OCHIN, Inc., an Oregon-based nonprofit health information network that operates in 18 states and serves over 2.5 million patients, has enabled its 78 safety net clinics, nearly half of which are in Oregon, to use OpenNotes since December 2013.

"I've found that OpenNotes is a great way to engage patients in their care," says Tim Burdick, MD, OCHIN's chief medical informatics officer and a practicing family physician at OHSU Family Medicine at Scappoose. "When we flipped the switch nationwide for all OCHIN clinics to use OpenNotes, I was pleased with how excited patients and providers were about this approach."

"With the advent of the electronic health record, it has become much easier to securely share notes among providers and, as a logical extension, with patients," says Homer Chin, MD, chairperson for the We Can Do Better campaign. "In light of the many benefits of doing so, it's time that we engage and empower patients by providing them with easy access to their own medical information."

Based at Harvard Medical School and Beth Israel Deaconess Medical Center, Tom Delbanco, MD, and Jan Walker, RN, MBA, created and continue to lead the OpenNotes initiative.

"This regional collaboration, remarkable both for its nature and the number of patients involved, represents a tremendous step toward engaging patients more actively in their care," Delbanco says. "In fact, it may prove pivotal in establishing full transparency as the national standard of care."

The OpenNotes initiative is funded primarily by the Robert Wood Johnson Foundation. It started with a one-year study that examined the impact of offering clinician notes to more than 13,000 patients cared for by 105 primary care doctors at three pilot sites. The preliminary studies found patients reporting feeling more in control of their care, having greater understanding of their medical conditions, and being more likely to take their medications as prescribed.

At the end of a year, 99 percent of patients asked for the practice to continue, and none of the doctors chose to withdraw.

Since 2012, OpenNotes has been spreading throughout the country in small and large health systems, currently affecting until now some 2 million patients. Non-profit Consumer Reports is working closely with the movement and recently identified OpenNotes as one of the top five innovations in health care in 2013. Major systems implementing this practice now include the Mayo Clinic and the Cleveland Clinic, in addition to Veterans Affairs.