New York State Health Foundation

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The New York and Presbyterian Hospital

  • Project Title: Implementing OpenNotes at an Accountable Care Organization
  • Priority Area: Empowering Health Care Consumers
  • Grant Amount: $199,908
  • Date Awarded: January 3, 2017
  • Region: New York City
  • Website: http://www.newyorkqualitycare.com
  • Grant Status: In Progress

Overview

Although health care consumers have access to growing amounts of health information, they are often left to tie together many pieces of information from their medical records. Notes from a doctor visit, on the other hand, are far more comprehensive and can facilitate organized care—but without written notes, patients may easily forget their doctor’s advice or get it wrong. Begun in 2010, OpenNotes is a national initiative to create partnerships toward better health and health care by giving everyone on the medical team, including the patient, access to the same information. For elderly patients who often have multiple medical conditions and a large team of providers and caregivers, OpenNotes can provide easier access to medical notes and improve care coordination. In 2017, NYSHealth awarded the New York and Presbyterian Hospital, an accountable care organization (ACO) known as NewYork Quality Care (jointly formed by NewYork-Presbyterian Hospital, Weill Cornell Medical College, and Columbia University College of Physicians and Surgeons) a grant to test OpenNotes among its elderly Medicare patients.

Under this grant, NewYork Quality Care will pilot OpenNotes throughout its three participating health system entities, which serves 31,000 Medicare patients of whom 29% are over the age of 80. This is a highly vulnerable population that has difficulty managing their care and navigating the health care system. Specifically, NewYork Quality Care will first test OpenNotes among the physicians who are the primary care providers for approximately 75% of the patients in the ACO. NewYork Quality Cares will then educate and engage the ACO’s remaining physicians with the goal of ultimately implementing OpenNotes across all Medicare patients. NewYork Quality Care will use its online patient portal to give patients access to OpenNotes and hire care managers and patient navigators to assist elderly patients who may be unfamiliar with using the portal to access their notes. Alternatively, NewYork Quality Care will also provide hard copies of medical notes to patients who are unwilling to use the portal. In addition, OpenNotes will provide technical assistance through in-person and online training for physicians and clinical support staff to use OpenNotes with their patients. NewYork Quality Care will produce a report to share key findings and lessons learned from implementing and using OpenNotes in an ACO setting, including whether it improved cost, utilization, and quality of health care services for its ACO patients.