Download PDF
Appl Clin Inform 2020; 11(01): 166-171
DOI: 10.1055/s-0040-1701679
Case Report
Georg Thieme Verlag KG Stuttgart · New York

Are You In or Are You Out? Provider Note Sharing in Pediatrics

Mario Bialostozky
1   Department of Emergency Medicine, Rady Children’s Hospital-San Diego, San Diego, California, United States
2   Department of Pediatrics, University of California, San Diego, California, United Sates
,
Jeannie S. Huang
2   Department of Pediatrics, University of California, San Diego, California, United Sates
3   Division of Pediatric Gastroenterology, Rady Children's Hospital-San Diego, San Diego, California, United States
,
Cynthia L. Kuelbs
2   Department of Pediatrics, University of California, San Diego, California, United Sates
4   Rady Children’s Hospital-San Diego, San Diego, California, United States
› Author Affiliations
Further Information

Publication History

20 October 2019

02 January 2020

Publication Date:
04 March 2020 (online)

Also available at
   Permissions and Reprints

Abstract

Background The OpenNotes initiative launched an international movement aimed at making health care more transparent by improving communication with, and access to, information for patients through provider note sharing. Little has been written either on provider note sharing in pediatric and adolescent populations or on the impact of system default settings versus voluntary provider note sharing.

Objective We describe our journey as a pediatric integrated delivery network to default share notes in ambulatory specialty practices not only with parent proxies but also with teens and discuss the methods that led to a successful implementation.

Methods Retrospective analysis of every ambulatory shareable medical provider note written in pediatric subspecialty clinics within an integrated pediatric delivery network from April 2017 through March 2019.

Results From April 2017 to February 2018, a total of 221,655 notes were shareable based on organizational policies, yet only 224 (0.1%) were actually shared with patients and families. After implementing a system of default release of notes from March 2018 to January 2019, a total of 224,960 notes were shareable, of which 191,379 (85%) were shared.

Conclusion Requiring providers to take an action to share notes (opt-in) results in few notes being shared while requiring providers to take an action to not share notes (opt-out) results in high levels of note sharing. We demonstrate that default release of notes in pediatric organizations to both proxies and teens is not only achievable but also likely to lead to increased provider note sharing with patients without obvious negative impact on providers or the organization.

Keywords

information sharing - open access to information - electronic health records and systems - communication - patient-provider - encounter notes - patient portal

Protection of Human and Animal Subjects

Our project was performed in compliance with the World Medical Association Declaration of Helsinki on Ethical Principles for Medical Research Involving Human Subjects, and was reviewed by the University of California, San Diego Institutional Review Board and given a waiver as a quality improvement project.


 

  • References

  • 1 Walker J, Darer JD, Elmore JG, Delbanco T. The road toward fully transparent medical records. N Engl J Med 2014; 370 (01) 6-8
    CrossrefPubMedGoogle Scholar
  • 2 Delbanco T, Walker J, Bell SK. , et al. Inviting patients to read their doctors' notes: a quasi-experimental study and a look ahead. Ann Intern Med 2012; 157 (07) 461-470
    CrossrefPubMedGoogle Scholar
  • 3 Weinert C. Giving doctors' daily progress notes to hospitalized patients and families to improve patient experience. Am J Med Qual 2017; 32 (01) 58-65
    CrossrefPubMedGoogle Scholar
  • 4 Sarabu C, Pageler N, Bourgeois F. OpenNotes: toward a participatory pediatric health system. Pediatrics 2018; 142 (04) e20180601
    CrossrefPubMedGoogle Scholar
  • 5 OpenNotes.org. Pediatrics & Adolescents. Available at: https://www.opennotes.org/tools-resources/for-health-care-providers/pediatrics-adolescents-clinicians . Accessed 2019
    PubMed
  • 6 Bourgeois FC, DesRoches CM, Bell SK. Ethical challenges raised by OpenNotes for pediatric and adolescent patients. Pediatrics 2018; 141 (06) e20172745
    CrossrefPubMedGoogle Scholar
  • 7 Johnson EJ, Goldstein DG. Defaults and donation decisions. Transplantation 2004; 78 (12) 1713-1716
    CrossrefPubMedGoogle Scholar
  • 8 Madrian BC, Shea DF. The power of suggestion: inertia in 401(k) participation and savings behavior. Q J Econ 2001; 116 (04) 1149-1187
    CrossrefPubMedGoogle Scholar
  • 9 Chapman GB, Li M, Colby H, Yoon H. Opting in vs opting out of influenza vaccination. JAMA 2010; 304 (01) 43-44
    CrossrefPubMedGoogle Scholar
  • 10 Agency for Healthcare Research and Quality. Patient Access to Medical Notes in Primary Care: Improving Engagement and Safety. Rockville, MD: Department of Health and Human Services, Agency for Healthcare Research and Quality; 2016
    Google Scholar
  • 11 Jenssen BP, Buttenheim AM, Fiks AG. Using behavioral economics to encourage parent behavior change: opportunities to improve clinical effectiveness. Acad Pediatr 2019; 19 (01) 4-10
    CrossrefPubMedGoogle Scholar
  • 12 Huang JS, Yueh R, Ma S, Cruz R, Bauman L, Choi LJ. Adolescents' and young adults' satisfaction with and understanding of medical notes from a pediatric gastroenterology practice: a cross-sectional cohort study. J Pediatr 2019; 215: 264-266
    CrossrefPubMedGoogle Scholar
  • 13 Galvin HK, Petersen C, Subbian V, Solomonides A. Patients as agents in behavioral health research and service provision: recommendations to support the learning health system. Appl Clin Inform 2019; 10 (05) 841-848
    Article in Thieme ConnectPubMedGoogle Scholar