Abstract
PURPOSEOpenNotes is a national movement established in 2010 that gives patients access to their visit notes through online patient portals, and its goal is to improve transparency and communication. To determine whether granting patients access to their medical notes will have a measurable effect on provider behavior, we developed novel methods to quantify changes in the length and frequency of use of n-grams (sets of words used in exact sequence) in the notes.METHODSWe analyzed 102,135 notes of 36 hematology/oncology clinicians before and after the OpenNotes debut at Beth Israel Deaconess Medical Center. We applied methods to quantify changes in the length and frequency of use of sequential co-occurrence of words (n-grams) in the unstructured content of the notes by unsupervised hierarchical clustering and proportional analysis of n-grams.RESULTSThe number of significant n-grams averaged over all providers did not change, but for individual providers, there were significant changes. That is, all significant observed changes were provider specific. We identified eight providers who were late note signers. This group significantly reduced its late signing behavior after OpenNotes implementation.CONCLUSIONAlthough the number of significant n-grams averaged over all providers did not change, our text-mining method detected major content changes in specific providers’ documentation at the n-gram level. The method successfully identified a group of providers who decreased their late note signing behavior.
Highlights
History has documented numerous efforts toward enabling patients to become more engaged in their own care
CONCLUSION the number of significant n-grams averaged over all providers did not change, our textmining method detected major content changes in specific providers’ documentation at the n-gram level
Coincident with the enactment of the Health Insurance Portability and Accountability Act was the rise in personal home computing and Internet access, which allowed for the development of online patient portals where patients could access summary information about their medications, immunizations, visits, and laboratory results online.[11,12]
Summary
History has documented numerous efforts toward enabling patients to become more engaged in their own care. Patients received open access to unstructured clinician notes in their electronic health records through online patient portals. OpenNotes began as a 12-month demonstration project with primary care physicians at three US institutions.[13] In surveys at the end of the pilot period, participating patients and doctors reported favorably on their experiences.[14] Since the original study, more than 100 institutions with over 30 million patients have implemented OpenNotes.[15]
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