Suzanne G Leveille1,2,3, Patricia Fitzgerald2, Kendall Harcourt2, Zhiyong Dong2, Sigall Bell2,3, Steve O'Neill2,3, Catherine DesRoches2,3, Leonor Fernandez2,3, Sara L Jackson4, Jared W Klein4, Rebecca Stametz5, Tom Delbanco2,3, Jan Walker6,7. 1. College of Nursing and Health Sciences, University of Massachusetts, Boston, MA, USA. 2. Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. 3. Harvard Medical School, Boston, MA, USA. 4. Division of General Internal Medicine, School of Medicine, University of Washington, Seattle, WA, USA. 5. Steele Institute of Health Innovation, Geisinger, Danville, PA, USA. 6. Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. Jwalker1@bidmc.harvard.edu. 7. Harvard Medical School, Boston, MA, USA. Jwalker1@bidmc.harvard.edu.
Abstract
BACKGROUND: Patients actively involved in their care demonstrate better health outcomes. Using secure internet portals, clinicians are increasingly offering patients access to their narrative visit notes (open notes), but we know little about their understanding of notes written by clinicians. OBJECTIVE: We examined patients' views on the clarity, accuracy, and thoroughness of notes, their suggestions for improvement, and associations between their perceptions and willingness to recommend clinicians to others. DESIGN: We conducted an online survey of patients in 3 large health systems, June-October 2017. We performed a mixed methods analysis of survey responses regarding a self-selected note. PARTICIPANTS: Respondents were 21,664 patients aged 18 years or older who had read at least 1 open note in the previous 12 months. MAIN MEASURES: We asked to what degree the patient recalled understanding the note, whether it described the visit accurately, whether anything important was missing, for suggestions to improve the note, and whether they would recommend the authoring clinician to others. KEY RESULTS: Nearly all patients (96%) reported they understood all or nearly all of the self-selected note, with few differences by clinician type or specialty. Overall, 93% agreed or somewhat agreed the note accurately described the visit, and 6% reported something important missing from the note. The most common suggestions for improvement related to structure and content, jargon, and accuracy. Patients who reported understanding only some or very little of the note, or found inaccuracies or omissions, were much less likely to recommend the clinician to family and friends. CONCLUSIONS: Patients overwhelmingly report understanding their visit notes and usually find them accurate, with few disparities according to sociodemographic or health characteristics. They have many suggestions for improving their quality, and if they understand a note poorly or find inaccuracies, they often have less confidence in their clinicians.
BACKGROUND: Patients actively involved in their care demonstrate better health outcomes. Using secure internet portals, clinicians are increasingly offering patients access to their narrative visit notes (open notes), but we know little about their understanding of notes written by clinicians. OBJECTIVE: We examined patients' views on the clarity, accuracy, and thoroughness of notes, their suggestions for improvement, and associations between their perceptions and willingness to recommend clinicians to others. DESIGN: We conducted an online survey of patients in 3 large health systems, June-October 2017. We performed a mixed methods analysis of survey responses regarding a self-selected note. PARTICIPANTS: Respondents were 21,664 patients aged 18 years or older who had read at least 1 open note in the previous 12 months. MAIN MEASURES: We asked to what degree the patient recalled understanding the note, whether it described the visit accurately, whether anything important was missing, for suggestions to improve the note, and whether they would recommend the authoring clinician to others. KEY RESULTS: Nearly all patients (96%) reported they understood all or nearly all of the self-selected note, with few differences by clinician type or specialty. Overall, 93% agreed or somewhat agreed the note accurately described the visit, and 6% reported something important missing from the note. The most common suggestions for improvement related to structure and content, jargon, and accuracy. Patients who reported understanding only some or very little of the note, or found inaccuracies or omissions, were much less likely to recommend the clinician to family and friends. CONCLUSIONS: Patients overwhelmingly report understanding their visit notes and usually find them accurate, with few disparities according to sociodemographic or health characteristics. They have many suggestions for improving their quality, and if they understand a note poorly or find inaccuracies, they often have less confidence in their clinicians.
Authors: Tom Delbanco; Jan Walker; Sigall K Bell; Jonathan D Darer; Joann G Elmore; Nadine Farag; Henry J Feldman; Roanne Mejilla; Long Ngo; James D Ralston; Stephen E Ross; Neha Trivedi; Elisabeth Vodicka; Suzanne G Leveille Journal: Ann Intern Med Date: 2012-10-02 Impact factor: 25.391
Authors: Sara L Jackson; Catherine M DesRoches; Dominick L Frosch; Sue Peacock; Natalia V Oster; Joann G Elmore Journal: Patient Educ Couns Date: 2017-11-08
Authors: Jan Walker; Suzanne Leveille; Sigall Bell; Hannah Chimowitz; Zhiyong Dong; Joann G Elmore; Leonor Fernandez; Alan Fossa; Macda Gerard; Patricia Fitzgerald; Kendall Harcourt; Sara Jackson; Thomas H Payne; Jocelyn Perez; Hannah Shucard; Rebecca Stametz; Catherine DesRoches; Tom Delbanco Journal: J Med Internet Res Date: 2019-05-06 Impact factor: 5.428
Authors: Lois McCloskey; Judith Bernstein; Linda Goler-Blount; Ann Greiner; Anna Norton; Emily Jones; Chloe E Bird Journal: Womens Health Issues Date: 2021-03-07