99 Who Reads Their Notes: Characteristics of Patients Viewing Notes in the Emergency Department Following an Open Notes Rollout

Abstract

The 21st Century CURES Act requires health care organizations and clinicians to share clinical notes authored by providers with patients. The Open Notes project has existed for several years, with the goal of having patients read their clinical notes to empower themselves and increase shared decision making between patients and clinicians. Emergency medicine literature regarding Open Notes is limited but emerging. We retrospectively collected six months of patient data from the electronic health record beginning in May 2021 at UC San Diego Health on emergency department patients, following our Open Notes rollout. We aim to describe the patient characteristics to understand which patients are reviewing their clinical notes. We performed a query in the UC San Diego Health emergency departments from May 1, 2021 to October 31, 2021 to obtain patient note metadata regarding note signed status, notes shared, sensitive notes blocked, note view times, note date, MyChart status (active vs inactive), assigned sex at birth, author type, author service, patient ID, note ID. We performed basic statistical analysis utilizing Microsoft Excel. A total of 42343 notes were signed on 23441 unique patients. There were 798/42343 (2%) total notes blocked. 11965/23441 (51%) were female, 11457/23441 were male (49%), and 19/23441 were unknown. The total number of unique patients with active MyChart status was 12757 with the following breakdown: 7459/12757 (58%) female, 5294/12757 (42%) male, 4/12757 unknown. Of the 42343 notes signed in the ED, 22326 notes were signed for patients with active MyChart accounts. 418/22326 (2%) of these notes were blocked from the patient by the author. Out of the group with an active MyChart, 6532/21908 (30%) non- blocked notes were viewed, which we will further discuss as “viewable notes.” Of these 12871/21908 (59%) were written for female patients, 9032/21908 (41%) were written for male patients, 5/21908 were unknown. 4088/12871 (31%) of notes written for female patients were read. 2443/9032 (27%) of notes were written for male patients were read. There were 10101 notes written by an attending physician out of 21908 (46%) and 3213/10101 (32%) of these notes were viewed. 9800/21908 (45%) were written by a trainee (resident physician or fellow) and 2738/9800 (30%) notes were viewed. 1990/21908 (9%) were written by a midlevel (nurse practitioner or physician assistant) and 574/1990 (29%) notes were viewed. 30% of viewable notes in patients with active MyChart accounts were viewed by the patient. Both the total notes blocked and notes blocked for patients with active MyChart accounts were approximately 2%, suggesting that the MyChart active status does not affect note sharing habits by the provider. Most of the notes available to view for active account holders were written by physicians; however, about a third of patients viewed their notes for each group: attending physician, resident/fellow, and midlevel. Our future areas of exploration with respect to our Open Note rollout include note block reason, living arrangement, patient gender identity, sexual orientation, ethnic background, race, and spoken language.