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OpenNotes: What Members of the Northwest OpenNotes Consortium Have Learned So Far

June 6, 2016
by Mark Hagland
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Homer Chin, M.D. will share the lessons learned to date around OpenNotes, with AMDIS Symposium attendees this month

As CMIOs and other medical informatics leaders gather together in Ojai, California, for the 25th Annual Physician-Computer Connection Symposium, sponsored as every year, by AMDIS (the Association of Medical Directors of Information Systems), one of those who will be speaking at the conference, to be held at the Ojai Valley Inn and Spa, will be Homer Chin, M.D., who until May 2013 was CMIO of Kaiser Permanente Northwest. The Portland, Ore.-based Dr. Chin remains an affiliate faculty member at Oregon Health and Sciences University. And he is the physician champion for the Northwest OpenNotes Consortium, a group of about 40 clinical informatics leaders in the Pacific Northwest, representing 11 health systems in the metropolitan area that encompasses Portland, Oregon and Vancouver, Washington, and which came together in 2013 to collaborate to promote the OpenNotes movement.

Dr. Chin has been helping to lead forward the Northwest OpenNotes Consortium for three years now,  since, at the point of his retirement from Kaiser Permanente Northwest, he was asked to lead the Consortium, which is promoting patient care organizations’ opening physician notes to patients. His title with regard to OpenNotes is Associate in Health Information Technology for OpenNotes.

Indeed, Dr. Chin, together with Alistair Erskine, M.D., CMIO of the Danville, Pa.-based Geisinger Health System, and the Portland-based John Santa, M.D., who until recently was director of the Consumer Reports Health Ratings Center, will speak on that very topic at the AMDIS Symposium this month. In that regard, he spoke recently with HCI Editor-in-Chief Mark Hagland about the OpenNotes movement, and what’s been learned at the Pacific Northwest OpenNotes Consortium, at Kaiser Permanente Northwest, and elsewhere about this important movement. Below are excerpts from that interview.

What was the original purpose, as you and colleagues from numerous health systems in your area gathered together three years ago, in creating the Pacific Northwest OpenNotes Consortium?

To begin with, we had asked Tom Delbanco, M.D. and Janice Walker, R.N., the co-directors of OpenNotes, to come out to talk with us, back in 2013. And after hearing from them, we decided to foster a collaboration among these normally competitive organizations, and move forward as a community. And one of the questions was, could we accelerate OpenNotes adoption collaboratively? And the answer was yes. They all agreed, and one of the things that we strategically put into place was that we said, we’re going to release a press release—we chose April 8, 2014 as the date for that announcement—and we said, if you want to be in the press release, you had to commit to implementing OpenNotes in 2014 or soon after. So that sort of spurred them on, and if they were willing to commit, they were in the press release, and if not, they wouldn’t be included. So most organizations did commit.

What were the processes like among those organizations, as they prepared to meet that date?

Well, once they decided, yes, we’re going to go forward, then Kaiser-Northwest, where I had just stepped down as CMIO, said, they were willing to go “big bang” with the implementation. Most organizations did so with small pilots. But my colleagues at Kaiser-Northwest just said, there’s enough evidence for this, and let’s just do it. So Tom and Jan came back and talked to Kaiser-Northwest, and help lead education and persuasion. And at Kaiser-Northwest, they decided to go ahead and implement it in April 2014, for their entire organization except for a few departments like mental health.

Was there any anxiety or resistance initially among physicians at Kaiser-Northwest?

Well, among the chiefs of the departments, when they saw the data, they agreed that we needed to do this. In the rank and file, some physicians weren’t as enthusiastic about OpenNotes, so one of the they things they decided was that the default would be availability to patients, but in a way that allowed for a box that opted out of a particular note that couldn’t be shared. So for those physicians feeling resistance, that gave them the option.

And what percentage clicked the box, and kept their particular notes closed?

Initially, it was a quarter of one percent. And that number has further decreased. It’s a very small percentage of one percent.

In other words, once they went live at Kaiser-Northwest, the physicians were happy and satisfied with it?

I would say, by and large. The thing that we hear is that it was a non-event. Physicians have a lot of reservations, but then you open up the medical record, and physicians concede that they haven’t heard anything about it. Occasionally, we get one physician here or there who reports that a couple of patients have complained. But the predominant thing we hear is that it was a non-event. And from the patient perspective, it’s all positive. So we’ve heard a lot of positive things that replicate the original studies, which find patients are more likely to be engaged in their care, more likely to take their medicines; their opinion of the healthcare system goes up, they’re more likely to approve of their physicians. And that happens with every organization that goes live.

Those were some of the main points you brought forward when you spoke at the AMDIS PCC Symposium last year?