Appl Clin Inform 2022; 13(01): 113-122
DOI: 10.1055/s-0041-1741483
State of the Art/Best Practice Paper

Lessons Learned from OpenNotes Learning Mode and Subsequent Implementation across a Pediatric Health System

Avinash Murugan
1   Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States
,
Holly Gooding
1   Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States
2   Section for Adolescent Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
,
Jordan Greenbaum
3   Stephanie V. Blank Center for Safe and Healthy Children, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
,
Jeanne Boudreaux
1   Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States
4   Aflac Cancer and Blood Disorders, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
,
Reena Blanco
1   Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States
5   Division of Emergency Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
,
Arin Swerlick
1   Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States
2   Section for Adolescent Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
,
Cary Sauer
1   Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States
6   Division of Gastroenterology, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
,
Steven Liu
7   GI Care for Kids, Atlanta, Georgia, United States
,
Amina Bhatia
1   Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States
8   Division of Pediatric Surgery, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
,
Alexis Carter
9   Department of Pathology and Laboratory Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
,
Meredith M. Burris
10   Office of the General Counsel, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
,
Lauren Becker
11   Privacy and Compliance, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
,
Lashandra Abney
12   Health Information Management, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
,
Sharon O'Brien
13   Information Services and Technology, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
,
Shane Webb
13   Information Services and Technology, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
,
Melissa Popkin
13   Information Services and Technology, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
,
Herb Williams
13   Information Services and Technology, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
,
Desiree Jennings
13   Information Services and Technology, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
,
Evan W. Orenstein
13   Information Services and Technology, Children's Healthcare of Atlanta, Atlanta, Georgia, United States
› Author Affiliations

Abstract

Background The 21st Century Cures Act has accelerated adoption of OpenNotes, providing new opportunities for patient and family engagement in their care. However, these regulations present new challenges, particularly for pediatric health systems aiming to improve information sharing while minimizing risks associated with adolescent confidentiality and safety.

Objective Describe lessons learned preparing for OpenNotes across a pediatric health system during a 4-month trial period (referred to as “Learning Mode”) in which clinical notes were not shared by default but decision support was present describing the upcoming change and physicians could request feedback on complex cases from a multidisciplinary team.

Methods During Learning Mode (December 3, 2020–March 9, 2021), implementation included (1) educational text at the top of commonly used note types indicating that notes would soon be shared and providing guidance, (2) a new confidential note type, and (3) a mechanism for physicians to elicit feedback from a multidisciplinary OpenNotes working group for complex cases with questions related to OpenNotes. The working group reviewed lessons learned from this period, as well as implementation of OpenNotes from March 10, 2021 to June 30, 2021.

Results During Learning Mode, 779 confidential notes were written across the system. The working group provided feedback on 14 complex cases and also reviewed 7 randomly selected confidential notes. The proportion of physician notes shared with patients increased from 1.3% to 88.4% after default sharing of notes to the patient portal. Key lessons learned included (1) sensitive information was often present in autopopulated elements, differential diagnoses, and supervising physician note attestations; and (2) incorrect reasons were often selected by clinicians for withholding notes but this accuracy improved with new designs.

Conclusion While OpenNotes provides an unprecedented opportunity to engage pediatric patients and their families, targeted education and electronic health record designs are needed to mitigate potential harms of inappropriate disclosures.

Protection of Human and Animal Subjects

This project consisted of operational work for institutional compliance with the 21st Century Cures Act, and IRB approval was not obtained.




Publication History

Received: 15 September 2021

Accepted: 01 December 2021

Article published online:
26 January 2022

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