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LIVE FROM THE CHIME-HIMSS FORUM: Are CIOs Prepared to Facilitate OpenNotes?

February 29, 2016
by Mark Hagland
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At the CHIME-HIMSS Forum on Monday, much discussion revolved around the OpenNotes initiative

In his speech to attendees at the CHIME-HIMSS Forum on Monday, Marc Probst, the CIO at the Salt Lake City-based Intermountain Healthcare, and incoming chairman of the board of the College of Healthcare Information Management Executives (CHIME) strongly emphasized some of the policy-oriented initiatives the association is pursuing, among them its National Patient ID Challenge, its exploration of partnerships for personalized medicine, and its new partnership with the OpenNotes initiative.

Just last week, CHIME had announced its partnership to accelerate information-sharing between patients and providers. In its Feb. 25 announcement, the association had quoted CHIME president and CEO Russell Branzell as stating that “We are seeing a tremendous swing toward value-based care and consumerism in healthcare. Patient engagement is a big part of that movement, but to be true partners in their care, patients must have access not only to their basic health records, but the notes that clinicians make during appointments. This partnership with OpenNotes is a terrific opportunity to promote innovative change in medical practice designed to increase patient engagement,” he was quoted as saying in the announcement.

That same announcement quoted OpenNotes leaders as well. “We’re learning that patients who read their notes feel more in control of their healthcare and are more likely to understand the treatment plan,” said Tom Delbanco, M.D., the co-founder, along with Jan Walker, R.N., MBA, of OpenNotes. Delbanco is the Koplow–Tullis Professor of General Medicine and Primary Care at Harvard Medical School and Beth Israel Deaconess Medical Center, in the Feb. 25 announcement. “OpenNotes represents a culture shift, and we’re hopeful that our relationship with CHIME will help us move closer to our goal of making openness the standard of care for all patients.”

Shortly after Probst’s speech on Monday morning, HCI Editor-in-Chief Mark Hagland queried national healthcare IT leaders on the opportunities and challenges inherent in CHIME’s advancing the OpenNotes initiative: Charles E. “Chuck” Christian, president and CEO of the Indiana Health Information Exchange and outgoing CHIME board chair; David Muntz, a consultant and the former Deputy National Coordinator in the Office of the National Coordinator for Health IT (ONC); Douglas Fridsma, M.D., Ph.D., president and CEO of the American Medical Informatics Association (AMIA), and former Chief Science Officer at ONC; and Brian Patty, M.D., CMIO at Rush University Medical Center in Chicago.

Asked about the challenges ahead in this area, Christian told HCI, “I think the face of healthcare is changing so much at this point in time. There’s a lot of change happening all at the same time. And those hospitals partnering with or acquiring physician practices for a variety of reasons are not only trying to figure out how to move forward and take advantage of relationships with patients and physicians, but they’re also trying to figure out how to mitigate any potential legal risk. And I think of my mom—is she really going to understand what the physician is putting into the note? So it’s clear that physicians will indeed need to be retrained in order to enter their notes appropriately, and even with regard to what should appear in notes.”

Still, Christian said, “The point is to get the patients more engaged in their own care. So this is moving towards greater patient engagement. And it’s really important to take a collaborative approach, a partnership approach, with patients, particularly around chronic care management.” Asked whether the healthcare system could get there in the next couple of years, he said, “We’ll have to get there. And at some point in time, everyone will have to pick up the ball. So if you’re a diabetic, you’re either going to have to be a part of the care team, or accept the consequences of not improving your health. That’s really where this is headed.”

“To me, this is not just another form of patient engagement,” Muntz told HCI. “It’s a critical aspect of it. And one of the things that’s nice is that it gives a patient who’s recovering or has recovered, the opportunity to find out what has occurred or is occurring, and allows them to interact with the data to get them into a course of action they might not otherwise be involved in. So it’s great.”

Fridsma said there is a big-picture aspect of how this situation is understood and framed. “People are concerned about patient-generated data,” he said. “But frankly, all data is patient-generated. And whether it’s the patient, or the patient’s caregiver, involved, creating the kind of engagement where they can not only see what’s there, but can contribute to it, can only improve the partnership between the patient on the one hand and their caregiver and their team on the other.”

With regard to the challenges of universalizing the OpenNotes approach, Fridsma said, “The challenge isn’t technical, it’s cultural. And I think that, as our new physicians come up who have lived in social media and used health information technology to run all the other aspects of their live, they’re going to see this as a natural extension of their lives. Part of the challenge is that health IT in itself is a useful tool, but we don’t equip our physicians to use it competently. There needs to be informatics literacy for the entire care team—physicians, nurses, pharmacists. It’s like if we were teaching doctors to be good users of prescriptions by having big pharma teaching them the fundamentals. So we need physicians to see information technology as a tool to enhance patient care rather than a barrier to getting what they want.”

Asked whether OpenNotes might become universalized in the next two or so years, Fridsma said, “I think it’s going to take time to make progress; it will take more than two years. But as the healthcare system shifts into the pay-for-performance and value-based purchasing paradigm, it will prove to be time well spent in retraining physicians on documentation, in order to improve remuneration.”

More importantly, he said, “We so often couch this subject in terms of the benefit to the provider, the hospital, and the insurer. But fundamentally, OpenNotes is about providing value to the patient. And if the patient can go to the doctor and be less inconvenienced, they’ll also start choosing physicians based on the ability to open up their notes and be engaged. I already do that myself, as a patient.”

Meanwhile, those who have helped transform their organizations into OpenNotes organizations say that the transition is not as difficult as might be expected, and absolutely is worth the effort. Brian Patty, M.D., CMIO at Rush University Medical Center, Chicago, noted that “We switched over to OpenNotes when we upgraded our Epic system in January, and everyone loves it. The doctors love it, the patients love it, and it has enhanced patient engagement. Why wouldn’t anyone want to do it?



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