Qualitative and Quantitative Analysis of Patients' Perceptions of the Patient Portal Experience with OpenNotes
21. September 2018
09. November 2018
02. Januar 2019 (online)
Background Access to medical encounter notes (OpenNotes) is believed to empower patients and improve the quality and safety of care. The impact of such access is not well understood beyond select health care systems and notes from primary care providers.
Objectives This article analyzes patients' perceptions about the patient portal experience with access to primary care and specialist's notes and evaluates free-text comments as an improvement opportunity.
Materials and Methods Patients at an academic health care system who accessed the patient portal from February 2016 to May 2016 were provided a link to complete a 15-item online survey. Those who had viewed at least one note were asked about patient characteristics, frequency of note access, note usefulness, note understanding, and if any action was taken after accessing the note. Free-text comments were associated with nine questions which were analyzed using qualitative methods.
Results A total of 23% (1,487/6,439) of patients who viewed the survey in the portal, participated. Seventy-six percent (1,126/1,487) knew that the notes were available on the portal, and of those, 957 had viewed at least one note to continue the survey. Ninety percent of those were older than 30 years of age, and 90% had some college education. The majority (83%) thought OpenNotes helped them take better care of themselves, without increasing worry (94%) or contacting the physician after reading the note (91%). The qualitative analysis of free-text responses demonstrated multiple positive and negative themes, and they were analyzed for potential improvement opportunities.
Conclusion Our survey confirms that patients who choose to access their primary care and specialists' online medical records perceive benefits of OpenNotes. Additionally, the qualitative analysis of comments revealed positive benefits and several potential patient portal improvement opportunities which could inform implementation of OpenNotes at other health systems.
KeywordsOpenNotes - patient portal - personal health record - patient engagement - patient experience - quality improvement - digital health
Protection of Human and Animal Subjects
No patient identifiers were included in this study. This study was approved by the institutional review board.
- 1 Crossing the Quality Chasm. A New Health System for the 21st Century. IOM Committee on Quality of Health Care in America. Washington, DC: National Academies Press; 2001. Available at: https://www.ncbi.nlm.nih.gov/pubmed/25057539 . Accessed February 15, 2018
- 2 Anonymous. Summary of the HIPAA Privacy Rule. HHS. Available at: https://www.hhs.gov/hipaa/for-professionals/privacy/laws-regulations/index.html . Accessed August 14, 2018
- 3 Delbanco T, Walker J, Bell SK. , et al. Inviting patients to read their doctors' notes: a quasi-experimental study and a look ahead. Ann Intern Med 2012; 157 (157) 461-470
- 4 Walker J, Meltsner M, Delbanco T. US experience with doctors and patients sharing clinical notes. BMJ 2015; 350: g7785
- 5 OpenNotes. Available at: https://opennotes.org . Accessed February 16, 2018
- 6 Patel V, Johnson C. Individual's use of online medical records and technology for health needs. ONC Data Brief. No. 40. April 2018. Available at: https://www.healthit.gov/sites/...03/HINTS-2017-Consumer-Data-Brief-3.21.18.pdf . Accessed August 5, 2018
- 7 VCU Annual Reports. Available at: https://annualreports.vcu.edu/vcuhealth/yir.html . Accessed September 15, 2018
- 8 SurveyMonkey. Available at: https://www.surveymonkey.com . Accessed February 1, 2016
- 9 Cerner HealtheLife Portal. Available at: https://www.cerner.com/solutions/patient-engagement . Accessed September 15, 2018
- 10 Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol 2006; 3: 77-101
- 11 Irizarry T, DeVito Dabbs A, Curran CR. Patient portals and patient engagement: a state of the science review. J Med Internet Res 2015; 17 (06) e148
- 12 Nazi KM, Turvey CL, Klein DM, Hogan TPVA, Woods SS. VA OpenNotes: exploring the experiences of early patient adopters with access to clinical notes. J Am Med Inform Assoc 2015; 22 (02) 380-389
- 13 Bell SK, Mejilla R, Anselmo M. , et al. When doctors share visit notes with patients: a study of patient and doctor perceptions of documentation errors, safety opportunities and the patient-doctor relationship. BMJ Qual Saf 2017; 26 (04) 262-270
- 14 Esch T, Mejilla R, Anselmo M, Podtschaske B, Delbanco T, Walker J. Engaging patients through open notes: an evaluation using mixed methods. BMJ Open 2016; 6 (01) e010034
- 15 Gerard M, Fossa A, Folcarelli PH, Walker J, Bell SK. What patients value about reading visit notes: a qualitative inquiry of patient experiences with their health information. J Med Internet Res 2017; 19 (07) e237
- 16 Mafi JN, Mejilla R, Feldman H. , et al. Patients learning to read their doctors' notes: the importance of reminders. J Am Med Inform Assoc 2016; 23 (05) 951-955
- 17 Klein JW, Jackson SL, Bell SK. , et al. Your patient is now reading your note: opportunities, problems, and prospects. Am J Med 2016; 129 (10) 1018-1021
- 18 Nazi KM, Turvey CL, Klein DM, Hogan TP. A decade of veteran voices: examining patient portal enhancements through the lens of user-centered design. J Med Internet Res 2018; 20 (07) e10413
- 19 Vodicka E, Mejilla R, Leveille SG. , et al. Online access to doctors' notes: patient concerns about privacy. J Med Internet Res 2013; 15 (09) e208
- 20 Mazor KM, Clauser BE, Field T, Yood RA, Gurwitz JH. A demonstration of the impact of response bias on the results of patient satisfaction surveys. Health Serv Res 2002; 37 (05) 1403-1417
- 21 Wright E, Darer J, Tang X. , et al. Sharing physician notes through an electronic portal is associated with improved medication adherence: quasi-experimental study. J Med Internet Res 2015; 17 (10) e226
- 22 Wolff JL, Darer JD, Berger A. , et al. Inviting patients and care partners to read doctors' notes: OpenNotes and shared access to electronic medical records. J Am Med Inform Assoc 2017; 24 (e1): e166-e172
- 23 Bell SK, Folcarelli PH, Anselmo MK, Crotty BH, Flier LA, Walker J. Connecting patients and clinicians: the anticipated effects of open notes on patient safety and quality of care. Jt Comm J Qual Patient Saf 2015; 41 (08) 378-384
- 24 Bell SK, Gerard M, Fossa A. , et al. A patient feedback reporting tool for OpenNotes: implications for patient-clinician safety and quality partnerships. BMJ Qual Saf 2017; 26 (04) 312-322