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Moving Ahead Into OpenNotes: One Medical Specialist and Medical Informaticist Shares Her View

August 2, 2016
by Mark Hagland
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Rush University Medical Center’s Allison Weathers, M.D. shares her perspectives on OpenNotes

As the OpenNotes movement, in which physicians and patient care organizations are sharing physician notes with patients following their doctor visits, moves ahead, the medical informaticists in patient care organizations across the U.S. are figuring out ways to help lead change among their fellow physicians. That is one element that was discussed by a variety of clinical and clinical informaticist leaders across the U.S. healthcare system, with the broad spectrum of advancement in this key area the subject of the July/August Healthcare Informatics cover story.

Among the medical informaticists interviewed for that cover story was Allison Weathers, M.D., associate CMIO at Rush University Medical Center, an academic medical center in downtown Chicago. Weathers, a practicing neurologist, believes it is very important for specialists to consider how valuable opening their notes to patients can be for their practices as well—not just the practices of primary care physicians. Below are excerpts from HCI Editor-in-Chief Mark Hagland’s interview with Dr. Weathers from earlier this summer.

So much attention has been paid to the value of OpenNotes in the sphere of primary care practice. But opening physician notes to patients can prove very valuable in the specialty care practice as well, correct?

Yes, that’s right. And this is one of the areas I’m really passionate about, the power that OpenNotes has to drive patient engagement. Everyone has this vision of what old-school neurology is like, but it’s totally different now. There’s this quote that patient engagement is the blockbuster drug of the 21st century—Dr. Leonard Kish—I think it’s a great quote. So I was a huge proponent of the patient portals here at Rush. I led a lot of the education for providers. Because everybody knows how to click at this point. So what does it mean to have patients messaging you, and so forth? That was our horizon in this area.

Allison Weathers, M.D.

And in the case of Rush University Medical Center, you were handed a bit of a timely opportunity as well, right?

Yes, that’s right. We were planning for an upgrade of our Epic EHR [electronic health record] in February of this year, anyway. It was a massive double upgrade from the version of Epic we had been on, and Epic was going to look and feel different anyway. So I said, this is a great opportunity; I have to get up in front of everybody to explain changes anyway, so why don’t we do this? So we got buy-in from hospital leadership and from the medical directors. And the bottom line is that this is the patient’s legal right to this information. Patients could get off a call and call health information management and get their legal record, anyway.

So what we chose to do was, for every next ambulatory visit from go-live, from February 8 on, all ambulatory notes as a default, were going to be released. However, at the individual note level, you always have the option to opt out. It’s a big blue box at the top of your screen. So if it’s going to be unduly upsetting or otherwise problematic, you can always choose to unshare the note. The data for mental health providers isn’t quite as strong yet, so for our psychologists and psychiatrists, their box is by default unchecked. So they have to go in and manually unclick it.

You’ve been in your position since January 2013, and have been working closely with Brian Patty, M.D., your organization’s CMIO, on all this, correct? And you’re also still practicing clinically part-time?

Yes, that’s correct. I always joke that Brian is kind of the vision and strategy guy, and I’m kind of the person in the weeds, working with the physicians. So it’s important for me to continue to practice, for that position. I’m an academic general neurologist; and I’m spending half of my time in clinical practice and half of my time in medical informatics.

It seems obvious to me that we need more specialists who are functioning as medical informaticists in patient care organizations, for so many reasons.

Yes. And it’s interesting, a lot of medical informaticists do come up through ED or primary care. But yes, it’s nice that I’ve been able to do that. Initially when I got involved, there weren’t that many neurologists who were involved. So I’ve gotten really involved with Epic, and I’m helping them to make their build better for neurologists, and with the American Academy of Neurology.

How many years have you been involved in informatics in some way?

I really began when I was still a fellow. The CMIO of Rush at the time needed someone to be a liaison to house staff, so I essentially became that liaison to our house staff, back in 2007.

Do you have any metrics yet on some of this advancement?

As of [April], over 83,000 notes had been shared. However, only about 33,000 of those notes were for MyChart-active patients. And only about 185 have actually been viewed, because we did this as a soft rollout. We said, we’re going to keep this quiet at the beginning, to make sure the doctors weren’t coming at me with pitchforks. Because the fear is that patients will call when the grammar is wrong or they don’t understand a word. But the studies have shown that that’s not true, they go to Google for that.