Avinash Murugan1, Holly Gooding1,2, Jordan Greenbaum3, Jeanne Boudreaux1,4, Reena Blanco1,5, Arin Swerlick1,2, Cary Sauer1,6, Steven Liu7, Amina Bhatia1,8, Alexis Carter9, Meredith M Burris10, Lauren Becker11, Lashandra Abney12, Sharon O'Brien13, Shane Webb13, Melissa Popkin13, Herb Williams13, Desiree Jennings13, Evan W Orenstein13. 1. Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States. 2. Section for Adolescent Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, United States. 3. Stephanie V. Blank Center for Safe and Healthy Children, Children's Healthcare of Atlanta, Atlanta, Georgia, United States. 4. Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, Georgia, United States. 5. Division of Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, United States. 6. Division of Gastroenterology, Children's Healthcare of Atlanta, Atlanta, Georgia, United States. 7. GI Care for Kids, Atlanta, Georgia, United States. 8. Division of Pediatric Surgery, Children's Healthcare of Atlanta, Atlanta, Georgia, United States. 9. Department of Pathology and Laboratory Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, United States. 10. Office of the General Counsel, Children's Healthcare of Atlanta, Atlanta, Georgia, United States. 11. Privacy and Compliance, Children's Healthcare of Atlanta, Atlanta, Georgia, United States. 12. Health Information Management, Children's Healthcare of Atlanta, Atlanta, Georgia, United States. 13. Information Services and Technology, Children's Healthcare of Atlanta, Atlanta, Georgia, United States.
Abstract
BACKGROUND: The 21st Century Cures Act has accelerated adoption of OpenNotes, providing new opportunities for patient and family engagement in their care. However, these regulations present new challenges, particularly for pediatric health systems aiming to improve information sharing while minimizing risks associated with adolescent confidentiality and safety. OBJECTIVE: Describe lessons learned preparing for OpenNotes across a pediatric health system during a 4-month trial period (referred to as "Learning Mode") in which clinical notes were not shared by default but decision support was present describing the upcoming change and physicians could request feedback on complex cases from a multidisciplinary team. METHODS: During Learning Mode (December 3, 2020-March 9, 2021), implementation included (1) educational text at the top of commonly used note types indicating that notes would soon be shared and providing guidance, (2) a new confidential note type, and (3) a mechanism for physicians to elicit feedback from a multidisciplinary OpenNotes working group for complex cases with questions related to OpenNotes. The working group reviewed lessons learned from this period, as well as implementation of OpenNotes from March 10, 2021 to June 30, 2021. RESULTS: During Learning Mode, 779 confidential notes were written across the system. The working group provided feedback on 14 complex cases and also reviewed 7 randomly selected confidential notes. The proportion of physician notes shared with patients increased from 1.3% to 88.4% after default sharing of notes to the patient portal. Key lessons learned included (1) sensitive information was often present in autopopulated elements, differential diagnoses, and supervising physician note attestations; and (2) incorrect reasons were often selected by clinicians for withholding notes but this accuracy improved with new designs. CONCLUSION: While OpenNotes provides an unprecedented opportunity to engage pediatric patients and their families, targeted education and electronic health record designs are needed to mitigate potential harms of inappropriate disclosures. Thieme. All rights reserved.
BACKGROUND: The 21st Century Cures Act has accelerated adoption of OpenNotes, providing new opportunities for patient and family engagement in their care. However, these regulations present new challenges, particularly for pediatric health systems aiming to improve information sharing while minimizing risks associated with adolescent confidentiality and safety. OBJECTIVE: Describe lessons learned preparing for OpenNotes across a pediatric health system during a 4-month trial period (referred to as "Learning Mode") in which clinical notes were not shared by default but decision support was present describing the upcoming change and physicians could request feedback on complex cases from a multidisciplinary team. METHODS: During Learning Mode (December 3, 2020-March 9, 2021), implementation included (1) educational text at the top of commonly used note types indicating that notes would soon be shared and providing guidance, (2) a new confidential note type, and (3) a mechanism for physicians to elicit feedback from a multidisciplinary OpenNotes working group for complex cases with questions related to OpenNotes. The working group reviewed lessons learned from this period, as well as implementation of OpenNotes from March 10, 2021 to June 30, 2021. RESULTS: During Learning Mode, 779 confidential notes were written across the system. The working group provided feedback on 14 complex cases and also reviewed 7 randomly selected confidential notes. The proportion of physician notes shared with patients increased from 1.3% to 88.4% after default sharing of notes to the patient portal. Key lessons learned included (1) sensitive information was often present in autopopulated elements, differential diagnoses, and supervising physician note attestations; and (2) incorrect reasons were often selected by clinicians for withholding notes but this accuracy improved with new designs. CONCLUSION: While OpenNotes provides an unprecedented opportunity to engage pediatric patients and their families, targeted education and electronic health record designs are needed to mitigate potential harms of inappropriate disclosures. Thieme. All rights reserved.
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Authors: Alisa Khan; Maitreya Coffey; Katherine P Litterer; Jennifer D Baird; Stephannie L Furtak; Briana M Garcia; Michele A Ashland; Sharon Calaman; Nicholas C Kuzma; Jennifer K O'Toole; Aarti Patel; Glenn Rosenbluth; Lauren A Destino; Jennifer L Everhart; Brian P Good; Jennifer H Hepps; Anuj K Dalal; Stuart R Lipsitz; Catherine S Yoon; Katherine R Zigmont; Rajendu Srivastava; Amy J Starmer; Theodore C Sectish; Nancy D Spector; Daniel C West; Christopher P Landrigan; Brenda K Allair; Claire Alminde; Wilma Alvarado-Little; Marisa Atsatt; Megan E Aylor; James F Bale; Dorene Balmer; Kevin T Barton; Carolyn Beck; Zia Bismilla; Rebecca L Blankenburg; Debra Chandler; Amanda Choudhary; Eileen Christensen; Sally Coghlan-McDonald; F Sessions Cole; Elizabeth Corless; Sharon Cray; Roxi Da Silva; Devesh Dahale; Benard Dreyer; Amanda S Growdon; LeAnn Gubler; Amy Guiot; Roben Harris; Helen Haskell; Irene Kocolas; Elizabeth Kruvand; Michele Marie Lane; Kathleen Langrish; Christy J W Ledford; Kheyandra Lewis; Joseph O Lopreiato; Christopher G Maloney; Amanda Mangan; Peggy Markle; Fernando Mendoza; Dale Ann Micalizzi; Vineeta Mittal; Maria Obermeyer; Katherine A O'Donnell; Mary Ottolini; Shilpa J Patel; Rita Pickler; Jayne Elizabeth Rogers; Lee M Sanders; Kimberly Sauder; Samir S Shah; Meesha Sharma; Arabella Simpkin; Anupama Subramony; E Douglas Thompson; Laura Trueman; Tanner Trujillo; Michael P Turmelle; Cindy Warnick; Chelsea Welch; Andrew J White; Matthew F Wien; Ariel S Winn; Stephanie Wintch; Michael Wolf; H Shonna Yin; Clifton E Yu Journal: JAMA Pediatr Date: 2017-04-01 Impact factor: 16.193
Authors: Michelle M Kelly; Catherine Arnott Smith; Peter L T Hoonakker; Carrie L Nacht; Shannon M Dean; Daniel J Sklansky; Windy Smith; Megan A Moreno; Anne S Thurber; Ryan J Coller Journal: Acad Pediatr Date: 2020-11-28 Impact factor: 3.107
Authors: Macda Gerard; Hannah Chimowitz; Alan Fossa; Fabienne Bourgeois; Leonor Fernandez; Sigall K Bell Journal: J Med Internet Res Date: 2018-05-24 Impact factor: 5.428