Empowering Health Care Consumers

Grantee Name

New York and Presbyterian Hospital

Funding Area

Empowering Health Care Consumers

Publication Date

July 2019

Grant Amount

$199,908

Grant Date:

January 2017–June 2018

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. 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 a grant to test OpenNotes among its elderly Medicare patients through its 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.)

Outcomes and Lessons Learned

  • Piloted OpenNotes throughout its three participating health system entities, which served 31,000 Medicare patients of whom 29% are over the age of 80.
  • Used its online patient portal to give patients access to OpenNotes and engaged care managers and patient navigators to assist elderly patients in accessing their notes.
  • Worked with Weill Cornell’s IT department to generate an e-mail to patients each time a note was shared, which included detailed instructions for patients on how to access their notes.
  • Enlisted Patient and Family Advisory Councils (PFACs) to elicit meaningful feedback on how to improve the OpenNotes pilot.
  • Engaged physicians and patients in sharing visit notes across its network:
    • In 2017, 174 clinicians shared 13,604 notes overall, with an 8% rate of notes viewed.
    • In 2018, the number of clinicians who shared notes increased to 239, with 34,058 notes shared overall.

Overall, primary care physicians shared the most notes, and 40% of the patients who viewed their notes and were surveyed went on to share their notes with a caregiver, family member, health care proxy, or other doctor.

A major challenge to implementing OpenNotes was rolling it out at each of the participating ACO entities, which collectively used four different electronic medical records (EMRs) with unique capabilities, limitations, and separate patient portal platforms. Beginning in March 2018, patients began receiving an OpenNotes e-mail notification when their notes were shared with them at Weill Cornell and the East Campus of the NewYork-Presbyterian Ambulatory Care Network (NYPACN) locations, which led to a significant increase in the percentage of notes viewed. Prior to this, the rate of notes viewed was 9%; shortly after the e-mail notifications went live, the monthly rate for notes viewed increased, peaking at 17%. From February 2017 through October 2018, the overall average at these two locations was 10% of notes viewed by 16% of patients who received a shared note.

The EMR system used by Weill Cornell/NYPACN East Campus is slated to become the sole EMR format used throughout the ACO’s participating health systems within three to five years. After the health systems transition over to one medical record and patient portal platform, OpenNotes will have a much bigger systemwide impact and reach greater number of patients; the ACO network continues to grow and currently serves approximately 38,000 patients.

NewYork Quality Care continues to encourage leadership to implement OpenNotes with an opt-out functionality. In October 2018, the primary care division at the NewYork-Presbyterian Medical Groups at Westchester went live with an OpenNotes opt-out functionality; since October 2018, 50,000 notes have already been shared. However, the rate of notes viewed continues to remain under 5%, primarily because it can be challenging to get Medicare patients to read their notes, as they tend to be slow adopters to technology. More targeted resources will be developed to improve patients’ engagement with their notes and increase the rate of notes viewed, which will benefit not just elderly Medicare patients but all patient populations.

The impact of NewYork Quality Care’s implementation of OpenNotes spanned beyond the ACO network and its Medicare patients, with participating providers sharing notes to all age groups and payer types. Because of the pilot’s success, over the next three to five years, OpenNotes will be rolled out throughout New York and Presbyterian Hospital’s entire system, which currently serves approximately 3.5 million patients. Continued focus on patient engagement strategies will be imperative for the success of this initiative.

 Co-Funding and Additional Funds Leveraged: N/A