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Appl Clin Inform 2022; 13(05): 1015-1023
DOI: 10.1055/a-1942-6889
Research Article

Effect of Notes' Access and Complexity on OpenNotes' Utility

Amro Khasawneh 
1   Industrial Engineering Department, School of Engineering, Mercer University, Macon, Georgia, United States
,
Ian Kratzke
2   Department of Surgery, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States
,
Karthik Adapa
3   Department of Radiation Oncology, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States
,
Lawrence Marks
3   Department of Radiation Oncology, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States
,
Lukasz Mazur
3   Department of Radiation Oncology, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States
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Abstract

Background Health care providers are now required to provide their patients access to their consultation and progress notes. Early research of this concept, known as “OpenNotes,” showed promising results in terms of provider acceptability and patient adoption, yet objective evaluations relating to patients' interactions with the notes are limited.

Objectives To assess the effect of the complexity level of notes and number of accesses (initial read vs. continuous access) on the user's performance, perceived usability, cognitive workload, and satisfaction with the notes.

Methods We used a 2*2 mixed subjects experimental design with two independent variables: (1) note's complexity at two levels (simple vs. complex) and (2) number of accesses to notes at two levels (initial vs. continuous). Fifty-three participants were randomly assigned to receive a simple versus complex radiation oncology clinical note and were tested on their performance for understanding the note content after an initial read, and then with continuous access to the note. Performance was quantified by comparing each participant's answers to the ones developed by the research team and assigning a score of 0 to 100 based on participants' understanding of the notes. Usability, cognitive workload, and satisfaction scores of the notes were quantified using validated tools.

Results Performance for understanding was significantly better in simple versus complex notes with continuous access (p = 0.001). Continuous access to the notes was also positively associated with satisfaction scores (p = 0.03). The overall perceived usability, cognitive workload, and satisfaction scores were considered low for both simple and complex notes.

Conclusion Simplifying notes can improve understanding of notes for patients/families. However, perceived usability, cognitive workload, and satisfaction with even the simplified notes were still low. To make notes more useful for patients and their families, there is a need for dramatic improvements to the overall usability and content of the notes.

Keywords

electronic health records - testing - evaluation - notes

Protection of Human and Animal Subjects

Participation was voluntary and does not pose undue risk. All human participants read and signed the informed consent form and all needed information was given to them when deciding whether to participate in the study. This was a remote unmoderated study and was fully implemented in Qualtrics.[42] The study protocol was reviewed and approved by the University of North Carolina at Chapel Hill Institutional Review Board (IRB) under reference ID: 338124.


Supplementary Material



Publication History

Received: 09 June 2022

Accepted: 11 September 2022

Accepted Manuscript online:
14 September 2022

Article published online:
26 October 2022

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