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OpenNotes: Frequently Asked Questions

Q: What is OpenNotes?
A: OpenNotes is sharing providers’ clinical documentation with their patients.

Q: Why are we doing this?
A: There are many reasons to share notes with patients. It leads to better engagement of patients, families and caregivers; increases patient satisfaction; and can improve safety and adherence. Increasingly, patients are considering OpenNotes when choosing which provider or health system to use for their care.

Q: Does OpenNotes improve actual outcomes?
A: Multiple survey studies have shown that patients prefer the transparency of OpenNotes and feel that it helps them to better manage their health. In a study published in 2015, patients with access to their providers’ notes had improved antihypertensive medication adherence. OpenNotes is also improving safety. A study that specifically invited and encouraged patients to provide online feedback about their notes found that fewer than 10 percent used the feedback tool, but two-thirds of the reported items were considered definite or possible safety concerns.

Q: How much extra work will this create for me?
A: Over 100 providers at Johns Hopkins have been participating in OpenNotes since 2015-2016. Most report no change in their workflow, and questions from patients about notes have been rare. Consistent with studies performed nationally, there was no overall change in phone and MyChart message volume for these pilot participants, although some individual providers might see a few extra or fewer messages per month. In situations where there is need to prevent a specific encounter from being shared via OpenNotes, it is quick and simple to do in the Wrap-Up section of the Visit Navigator. See the OpenNotes tip sheet for more details.  

Q: Do I need to change how I write my notes?
A: Providers should not change how they document simply because of OpenNotes. While some providers choose to use less lingo or medically complex words in their notes, studies show that this is not necessary. Patients are generally able to understand enough of their providers’ notes to make sense of them without increased anxiety or confusion. It is always good practice to write your notes with the expectation that a patient might eventually read them, avoiding use of judgmental, derogatory or insulting language.

Q: Does this benefit providers at all?
A: OpenNotes studies report improved provider satisfaction when patients read their notes and become more engaged and more adherent with the care plan. Some providers also report improved efficiency with OpenNotes, because they invite patients to review the plan section of their notes in MyChart, rather than entering patient instructions for the printed After Visit Summary. 

Q: What encounter types are affected?
A: At this point, we are only sharing notes from office visits, hospital outpatient department (HOD) appointments, video visits and similar ambulatory encounters. Discharge summaries, inpatient progress notes, operative notes, e-visits, telephone encounters, patient email encounters (MyChart messages) and documentation encounters are not included.

Q: What note types are shared?
A: All notes from an ambulatory or HOD encounter are shared, unless the encounter provider uses the Visit Navigator section to prevent release of that encounter’s notes. This includes all documentation from all providers and staff in that encounter, including physicians, advanced practice providers, nurses, medical assistants, students and anyone else who writes or contributes to a note. Affected note types include, but are not limited to, progress notes, problem-oriented Assessment & Plan notes, H&P notes, pre-operative notes, procedure notes and student notes.

Q: When and where will notes be visible?
A: Notes are made available as soon as the encounter is closed. Patients are not able to see notes prior to the encounter being closed.

Notes are visible only in MyChart and are accessed from the list of past appointments. Notes are not displayed on the printed After Visit Summary (AVS).

Q: What about notes from prior to March 1, 2018?
A: Notes are not displayed from prior to a provider’s participation in OpenNotes. If you have been part of one of the pilot OpenNotes waves since July 2015, your notes will continue to be available from the date of your initial participation. If you haven’t been part of a pilot wave, patients will only have access to your notes written on or after March 1, 2018.

Q: What if a patient requests a change to my note?
A: You are not required to change any note based on a patient request. If you receive a message from a patient requesting to correct an error or add information to your note, and you agree with the request, you are welcome and encouraged to reopen (addend) the encounter and make the requested change.

If you and the patient disagree, you are encouraged to discuss this further with the patient to try to reach consensus. It may be appropriate to ask the patient to return for an office visit for that discussion. If you cannot come to an agreement, the patient has the right to file a formal written amendment request and should be provided a copy of the Request to Amend form. (Please note this is a link to our internal intranet and should not be provided directly to patients.) In these situations, either the Johns Hopkins Privacy Office or one of the Health Information Management (HIM) offices will contact you with the details of the request and instructions on next steps. Formal amendment requests require a response within 60 days.

Q: Can patient proxies see the notes?
A: Proxies are people with access to a patient’s MyChart account. The most common example is parents or guardians accessing their child’s account. Since clinical notes may contain sensitive information, they are treated similarly to other sensitive information, such as test results and problem, allergy and medication lists. Proxies of adolescents and schedule-only adult proxies cannot view OpenNotes, but proxies of children and full-access adult proxies can.

Q: Where can I learn more about OpenNotes?
A: Check out the Johns Hopkins Epic Tip Sheet for OpenNotes. You can learn more about the OpenNotes project, including research results, testimonials and additional FAQs, at opennotes.org