NYC Health + Hospitals

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.

Begun in 2010, OpenNotes is a national effort to create partnerships toward better health and health care by giving everyone on the medical team, including the patient, access to the same information. When patients have access to their own visit notes, they better remember what was discussed during visits; feel more in control of their care; are more likely to take medications as prescribed; and can share notes with their caregivers. While OpenNotes has spread nationally, its expansion within New York State has been limited. In 2016, NYHealth awarded a grant to NYC Health + Hospitals (H+H) to launch OpenNotes at the largest public hospital system in the country, providing access to medical visit notes for patients who traditionally lack such health information.

Under this grant, H+H determined how to best implement OpenNotes within its system. Specifically, H+H undertook pilot studies across adult ambulatory and behavioral health care settings at three of its hospital sites: Bellevue, Kings County, and Elmhurst. Each hospital initially tested implementation approaches and monitored effectiveness among a small cohort of patients, with the goal of ultimately launching OpenNotes systemwide so that all H+H patients will be able to access their medical notes. H+H collaborated with the Behavioral Insights Team for North America to test the note-sharing process (in person at the clinic and through mail and an online portal) and patient reminders and prompts in between appointments. In addition, OpenNotes provided technical assistance through in-person and online training for physicians and clinical support staff.