Foundations Raise $10 Million To Expand OpenNotes Project


A group of four foundations has partnered to establish a $10 million fund that will be used to expand the OpenNotes program from its current state as an experimental patient engagement strategy to an established national program with the potential of reaching 50 million patients. Cambia Health Foundation, Gordon and Betty Moore Foundation, Peterson Center on Healthcare, and the Robert Wood Johnson Foundation will fund the initiative. OpenNotes is the concept of providing patients with full, transparent access to their medical records including all provider notes. The investment is designed to fund expansion efforts for the next three years. OpenNotes will use the funding to help new providers implement OpenNotes and to measure the impact that OpenNotes has on health outcomes and cost containment.

OpenNotes began as an experiment at Beth Israel Deaconess Medical Center in 2010. A Robert Wood Johnson Foundation funded study was conducted in which 105 primary care providers expanded their patient portals to provide complete access to patient notes for one year. During that time, 13,564 patients had at least one note entered into the system by one of the providers. 84 percent of the patient population included in the study logged into the patient portal and read their providers note. Nationally, patient portal utilization rates tend to be much lower than that, hovering in the 20 to 30 percent range, with subtle variations for patient age and provider group size. The patients that did access their records were asked to complete a survey at the end of the study. 87 percent of those that responded indicated that reading their provider’s notes helped them feel more in control of their care, while 60 to 78 percent reported an increase in medication adherence. Only one to eight percent of respondents reported that the notes caused confusion, worry, or offense.

Based on these promising initial findings, researchers at Geisinger Health System launched its own OpenNotes program to objectively confirm BIDMC’s findings, particularly the patient’s reported improvement to medication adherence. To measure this, Geisinger ran a retrospective study of a group of patients being seen at a Geisinger primary care practice that were prescribed at least one antihypertensive or antihyperlipidemic agent at the time of the study. Only patients that were also enrolled in Geisingers health insurance plan were included in the study and, as a result, prescription refill information was able to measure medication adherence between the study participants and the control group. Researchers analyzed records from patients that had been given access to their provider notes, and compared their medication adherence rates with similar patients that had not been given access to their providers notes. Researchers found that there was a small but measurable increase in medication adherence among the group that had been granted access to their providers notes.

With small but persistently promising results coming out of the OpenNotes initiative, the project now has the funding it needs to help push its concept out to a significantly larger patient population, which will ultimately enable researchers to run more comprehensive retrospective studies on its value.

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