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How OpenNotes Builds Patient Engagement

 |  By Jennifer Thew RN  
   May 19, 2015

Patients are encouraged to become engaged in their healthcare, but they can't do it unless providers give them the tools and information they need to actively participate.

Everyone agrees that patient engagement is important. No one agrees on what, exactly, the term means. A 2012 study published in the Journal of Participatory Medicine, "The Many Faces of Patient Engagement," concluded that there is a lack of "consistency in terminology and definitions around the concept of patient engagement."

The presenters of a session at the HIMSS 2015 conference last month, "Shaping the Frontier of Patient Engagement: A CNO/CNIO Perspective," grapple with the nebulous nature of patient engagement. Laura J. Wood, DNP, MS, RN, who is senior vice president for patient care service and chief nursing officer at Boston (MA) Children's Hospital, and Mary Beth Mitchell, MSN, RN, BC, CPHIMS, the chief nursing informatics officer at Texas Health Resources in Arlington, TX, discussed the CNO and CNIO perspectives on the evolution of patient engagement.

Despite the debate over definition and application of patient engagement, Mitchell boils it down to a single, simple description: "It's how patients become invested in their own health."

Patients like OpenNotes
One method Boston Children's is using to increase patient engagement is OpenNotes, the national initiative from the Robert Wood Johnson Foundation. The effort began in 2010 when primary care physicians at three healthcare institutions began sharing visit notes online with their patients. The sites were part of a year-long study to explore how sharing clinician's notes affected care. The results found that patients frequently accessed visit notes, reported a greater sense of control and understanding of their medical issues, had improved recall of care plans, and adhered better to medication regimens. Almost all patients wanted the practice to continue, and no physicians had opted out after a year. There are now 30 hospitals and health systems participating in the OpenNotes initiative.

"OpenNotes is a wonderful example of patient and family participation in their care, and what I think may be a harbinger of really meaningful activation," Wood says. "There's kind of a no-turning-back once you move on this, it seems."

Engagement requires transparency
In my opinion, providers need to be more proactively turning towards the type of patient engagement that, like OpenNotes, fosters healthcare transparency. Healthcare professionals play an enormous role in cultivating patient engagement because they're the ones who provide the tools and information necessary for patients to participate in their healthcare. Patient engagement is a two-way street, and I've personally seen how a providers who don't foster engagement can negatively influence a patient's health.

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.

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