Patients Learning to Read Their Doctors' Notes

The Importance of Reminders

Published in: Journal of the American Medical Informatics Association, v. 23, no. 5, Sep. 2016, p. 951-955

Posted on RAND.org on September 13, 2016

by John N. Mafi, Roanne Mejilla, Henry Feldman, Long Ngo, Thomas L. Delbanco, Jonathan Darer, Christina Wee, Jan Walker

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OBJECTIVE: To examine whether patients invited to review their clinicians' notes continue to access them and to assess the impact of reminders on whether patients continued to view notes. MATERIALS AND METHODS: We followed OpenNotes trial participants for 2 years at Beth Israel Deaconess Medical Center (BIDMC) and Geisinger Health System (GHS). Electronic invitations alerting patients to signed notes stopped at GHS after year 1, creating a natural experiment to assess the impact of reminders. We used generalized linear models to measure whether notes were viewed within 30 days of availability. RESULTS: We identified 14 360 patients (49 271 visits); mean age 52.2; 57.8% female. In year 1, patients viewed 57.5% of their notes, and their interest in viewing notes persisted over time. In year 2, BIDMC patients viewed notes with similar frequency. In contrast, GHS patients viewed notes far less frequently, a change starting when invitations ceased (RR 0.29 [0.26–0.32]) and persisting to the end of the study (RR 0.20 [0.17–0.23]). A subanalysis of BIDMC patients revealed that black and other/multiracial patients also continued to view notes, although they were overall less likely to view notes compared with whites (RR 0.75 [0.67–0.83] and 0.93 [0.89–0.98], respectively). DISCUSSION: As millions of patients nationwide increasingly gain access to clinicians' notes, explicit email invitations to review notes may be important for fostering patient engagement and patient-doctor communication. CONCLUSION: Note viewing persists when accompanied by email alerts, but may decline substantially in their absence. Non-white patients at BIDMC viewed notes less frequently than whites, although their interest also persisted.

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