Empowering Health Care Consumers

Grantee Name

NYC Health + Hospitals

Funding Area

Empowering Health Care Consumers

Publication Date

July 2019

Grant Amount

$274,175

Grant Date:

August 2016 – February 2018

Although patients 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. OpenNotes is an international movement 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.

In 2016, NYSHealth 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.

Outcomes and Lessons Learned

  • Piloted OpenNotes in all outpatient settings, except behavioral health, at three of its hospital sites (Elmhurst, Queens, and Coney Island), first testing implementation approaches and monitoring effectiveness among a small cohort of patients.
  • Partnered with Behavioural Insights Team, GetMyHealth Data, and the Boston OpenNotes team to develop a strategy to increase patients’ engagement with their notes.
  • Achieved the following results by close of the grant project:
    • 174 departments had implemented OpenNotes;
    • 1,476 providers shared 374,310 notes;
    • More than 23,800 patients were enrolled on H+H’s online patient portal and had access to their medical notes; and
    • More than 2,100 patients had read their notes.

H+H collaborated with its internal IT teams and Behavioural Insights Team to design and test different interventions to increase patient enrollment and engagement with their clinical notes. H+H implemented many of these solutions by providing information about OpenNotes to patients at several points throughout the patient journey. For example, existing patients who had previously created an online portal account were notified by e-mail every time their doctor shared a note with them. Hospital call center representatives were given scripts with information about OpenNotes to share with patients by phone. H+H worked with its electronic medical record vendor to rename the “My Notes” label to “My Doctor’s Notes” in the patient portal so that patients could more easily find their clinical notes. H+H also launched a webinar series and social media campaign to educate patients about OpenNotes.

H+H also collected feedback from patients. Survey results revealed that patients appreciated having access to their clinical notes and were very likely to recommend reading clinical notes to their friends and family. The majority of patients took some action after reading their notes, such as looking something up online or writing down questions to ask their provider at the next visit. Patients also shared suggestions on how to improve patient portal functionality and increase readability of clinical notes.

Overall, H+H found that the piloting OpenNotes throughout its system did not pose a significant problem to clinical operations, workflow, or privacy. The pilot ultimately created the possibility for an overall improved patient experience—empowering patients to understand and play an active role in their care.

Since the end of the grant, H+H’s OpenNotes program has continued to grow. As of spring 2019:

  • 280 departments have implemented OpenNotes.
  • 2,088 providers are participating in the project.
  • 18,000 patients are enrolled through H+H’s online patient portal to automatically have access to OpenNotes, and nearly 2,700 patients have read their notes.

OpenNotes is now part of standard implementation of H+H’s Epic electronic health records system. By the end of 2019, all outpatient facilities will be on Epic, and all H+H patients on Epic’s patient portal will have access to their clinical notes across participating specialties. H+H’s systemwide approach to telehealth is also accelerating use of OpenNotes, and it is implementing other tools, such as mobile apps, text-based interventions, and video visits, to better support patients in reaching their health goals.

This project paved the way for further NYSHealth investments in OpenNotes throughout New York State—first at other hospital systems and then to all settings in which patients receive care. NYSHealth next supported a project to make OpenNotes available to patients of a Medicare accountable care organization in New York City formed by NewYork-Presbyterian Hospital, Weill Cornell Medical College, and Columbia University College of Physicians and Surgeons. To help foster its spread beyond New York City, NYSHealth also issued a Request for Proposals (RFP), awarding awarding $1 million to help eight hospital systems in New York State adopt or spread OpenNotes and spur patient and provider engagement. NYSHealth followed up with an RFP to support OpenNotes in federally qualified health centers, multispecialty group practices, hospital-affiliated physician groups, independent physician practices, and other health care settings across New York State. Through these combined efforts, nearly 1.4 million visit notes have been shared in New York State to date—giving patients and their caregivers more control over their care.

Co-Funding and Additional Funds Leveraged: N/A