Nav: Home

OpenNotes reporting tool engages patients as safety partners

December 14, 2016

BOSTON - OpenNotes evidence has shown that transparent medical records can increase patient engagement - patients who read the clinical notes written by their doctors report feeling more in control of their care and being better able to adhere to the treatment plan. Now new research from OpenNotes investigators at Beth Israel Deaconess Medical Center (BIDMC) suggests that offering patients a mechanism to provide feedback about their notes further enhances engagement and can improve patient safety.

The study results appear online today in the British Medical Journal (BMJ) Quality and Safety.

"Our findings add to a growing literature suggesting that patients can help identify mistakes," says lead author, Sigall Bell, MD, OpenNotes Director of Patient Safety and Discovery and Associate Professor of Medicine at Harvard Medical School. "We were struck that nearly all patients and care partners in the study found the feedback tool valuable. What that indicates to us is that patients are eager to help their health care teams 'get it right.'"

What's more, Bell says, the majority of patients who reported a possible inaccuracy also provided positive feedback, with one doctor commenting that it was an 'anti-burnout' experience.

Bell and colleagues created a simple, low cost, online feedback tool that patients could link to from their notes on the secure, patient portal. 41 doctors signed on to the pilot intervention, and 6225 patient visits were included in the one year study period. During that time 44 percent of patients read their notes, and among them one in 12 used the reporting tool.

Bell found that nearly all (96 percent) of the patients who sent feedback reported understanding the content of the note. Among those who provided feedback, 23 percent reported potential safety concerns, most commonly citing possible mistakes regarding medications, or documentation of existing health problems or symptoms. Upon clinician review, 64 percent of the patient reported items were confirmed as definite or possible safety concerns, and 57 percent of the cases resulted in a change to the record or care.

Bell says that what didn't happen during the study period is equally as important. Although some clinicians worried that identification of errors in notes may adversely affect the patient-doctor relationship, not a single doctor in the small pilot reported such an event. After a year, 99 percent of patients and care partners found the tool valuable, 97 percent wanted it to continue, and none of the doctors reported worsening workflow.

"We were pleased to find that the OpenNotes reporting tool helped to identify quality improvement opportunities without appearing to add to clinician burden," says Bell. "We believe that if patients know their feedback is welcome and encouraged, the potential to reduce errors or clear up confusion about the care plan will be even greater."

The reporting tool is currently being piloted at Boston Children's Hospital under the guidance of Fabienne Bourgeois, MD, MPH , pediatric hospitalist and the Medical Director of Patient-Facing Applications.
In addition to Bell, study authors include Macda Gerard; Alan Fossa MPH; Tom Delbanco, MD; Barbara Sarnoff Lee, LICSW; Kenneth Sands, MD; Patricia Folcarelli, PhD; and Jan Walker, RN, MBA all of Beth Israel Deaconess Medical Center.

Dr. Bell's research is supported by CRICO/Risk Management Foundation of the Harvard Medical Institutions.

About OpenNotes

OpenNotes is a national movement that invites patients, families and clinicians to come together and improve communication through shared clinicians' notes and fully transparent medical records. The movement is supported by the Robert Wood Johnson Foundation, Gordon and Betty Moore Foundation, the Peterson Center on Healthcare and Cambia Health Foundation. Learn more at

Beth Israel Deaconess Medical Center

Related Patient Safety Articles:

EHR medication lists lack accuracy, may threaten patient safety
Almost 1 in 4 medications were mismatched between the clinician's notes and the formal medication list in a patient's electronic medical record, according to study of ophthalmic medications by Kellogg Eye Center.
Using facial recognition technology to continuously monitor patient safety in the ICU
A team of Japanese scientists has used facial recognition technology to develop an automated system that can predict when patients in the intensive care unit (ICU) are at high risk of unsafe behaviour such as accidentally removing their breathing tube, with moderate (75%) accuracy.
Speaking up for patient safety
In a new study, a team led by clinician-researchers at Beth Israel Deaconess Medical Center (BIDMC) surveyed family members and patients with recent ICU experiences about their willingness to speak up about care concerns to medical providers.
Serious mortuary errors could be reduced by applying common patient safety protocols
New research investigating serious incidents occurring in the management of patient remains after their death concludes that safe mortuary care may be improved by applying lessons learned from existing patient safety work.
Listening to the patient's voice: A more patient-centered approach to medication safety
Involving the patient is critical for improving medication safety according to Regenstrief Institute researcher and Indiana University School of Medicine assistant professor of medicine Joy L.
More Patient Safety News and Patient Safety Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Erasing The Stigma
Many of us either cope with mental illness or know someone who does. But we still have a hard time talking about it. This hour, TED speakers explore ways to push past — and even erase — the stigma. Guests include musician and comedian Jordan Raskopoulos, neuroscientist and psychiatrist Thomas Insel, psychiatrist Dixon Chibanda, anxiety and depression researcher Olivia Remes, and entrepreneur Sangu Delle.
Now Playing: Science for the People

#537 Science Journalism, Hold the Hype
Everyone's seen a piece of science getting over-exaggerated in the media. Most people would be quick to blame journalists and big media for getting in wrong. In many cases, you'd be right. But there's other sources of hype in science journalism. and one of them can be found in the humble, and little-known press release. We're talking with Chris Chambers about doing science about science journalism, and where the hype creeps in. Related links: The association between exaggeration in health related science news and academic press releases: retrospective observational study Claims of causality in health news: a randomised trial This...