at …… 4.7.16 1

About OpenNotes A national movement with more than 12 million patients with access to their clinician notes Includes thousands of doctors, nurses, therapists, trainees, physician assistants, case managers, and other care givers sharing notes Began with a three-institution study in 2010, involving 105 primary care physicians and 20,000 of their patients. ----- Meeting Notes (9/23/15 14:09) ----- 20 000 INVITED ONE YEAR NOW LOOK!!!! 10.24.16

About the OpenNotes Study 1-year Demonstration Project summer 2010 – summer 2011 (and still ongoing) Patients invited to view their PCPs’ signed notes via secure portals (only notes signed during the project – not retroactive) Each patient notified automatically via secure e-mail message when a note was signed, and later reminded to review note(s) before next visit Patients and doctors completed surveys before and after, and we collected administrative data (portal clicks, e-mail volume) ----- Meeting Notes (9/22/15 12:18) ----- 20 000 PATIENTS ----- Meeting Notes (9/23/15 14:09) ----- ONE DIAGNOSIS AND SIX PATIENTS IN 10 MINUTES! SHOW YOU THE IMPACT OF FULLY TRANSPARENT NOTES INCLUDING THE DOC MR A DIAGNOSIS? TREATMENT? ----- Meeting Notes (9/23/15 14:38) ----- TELL THE STORY. 40 YRS MR A CIGS BEER FAMILY WONT WRITE DOWN UNLESS YOU THINK.... 10.24.16

About the OpenNotes Study Three Principal Questions Would OpenNotes help patients become more engaged in their care? Would OpenNotes be the straw that breaks the doctor’s back? After 1 year, would patients and doctors want to continue? ----- Meeting Notes (9/22/15 12:18) ----- 20 000 PATIENTS ----- Meeting Notes (9/23/15 14:09) ----- ONE DIAGNOSIS AND SIX PATIENTS IN 10 MINUTES! SHOW YOU THE IMPACT OF FULLY TRANSPARENT NOTES INCLUDING THE DOC MR A DIAGNOSIS? TREATMENT? ----- Meeting Notes (9/23/15 14:38) ----- TELL THE STORY. 40 YRS MR A CIGS BEER FAMILY WONT WRITE DOWN UNLESS YOU THINK.... 10.24.16

About the OpenNotes Study Three out of four patients reported taking better care of themselves understanding their health and medical conditions better feeling more in control of their health and health care being better prepared for visits doing better with taking their medications as prescribed ----- Meeting Notes (9/22/15 12:18) ----- 20 000 PATIENTS ----- Meeting Notes (9/23/15 14:09) ----- ONE DIAGNOSIS AND SIX PATIENTS IN 10 MINUTES! SHOW YOU THE IMPACT OF FULLY TRANSPARENT NOTES INCLUDING THE DOC MR A DIAGNOSIS? TREATMENT? ----- Meeting Notes (9/23/15 14:38) ----- TELL THE STORY. 40 YRS MR A CIGS BEER FAMILY WONT WRITE DOWN UNLESS YOU THINK.... 10.24.16

The Bottom Line for Patients They want to read, understand, and be educated about their notes 99% of patients want to read their medical notes online 4 out of 5 patients say that the availability of OpenNotes would impact their choice of provider OpenNotes does not change the confidential relationship between the patient and provider, but about 40% of patients share notes with family, caregivers/care partners, and others involved in their care 10.24.16 6

What did we learn from the clinicians? About 50% expected a change to workflow, but those concerns did not bear out. There was minimal impact on workflow with only 3% reporting longer visits or more questions. Patients were rarely worried or confused by notes. Clinicians reported little change in the way they wrote notes, and those who did, remarked the changes were minor and doable, such as using less jargon and spelling out abbreviations and acronyms. 3 out of 4 doctors said they would like their patients to see notes online, and at the end of the trial, not one doctor asked to stop sharing notes Clini 4.7.16

The Power of Open Notes “Nothing About Me Without Me” Sept. 28, 2011 The Power of Open Notes “Nothing About Me Without Me” A new medicine that brings benefits … and risks A catalyst for change… and not only in ambulatory care An opportunity to Partner with patients And improve safety ----- Meeting Notes (9/23/15 14:09) ----- POETS STORYTELLERS THEATRE ARTIST DOC SOCIAL SCIENTISTS ENGAGEMENT COMMUNICATION SHARING ALL THROUGH FULL TRANSPARENCY CARL: TRUST ----- Meeting Notes (9/23/15 14:31) ----- CARL CARL CARL WHAT IT MEANS ON THE WESTCOAST TO CARL Delbanco, Berwick, et al., Health Expectations, 2011 10.24.16 (c) 2011 ePatientDave.com

Factor: Patient Safety Don’t forget to save the videos into the same folder as the PowerPoint file to play the presentation! ----- Meeting Notes (9/23/15 14:09) ----- ANOTHER SET OF EYES REPORTING TOOL CANDICE ----- Meeting Notes (9/23/15 14:38) ----- CANDICE CANDICE 10.24.16

Factor: Medication Adherence ----- Meeting Notes (9/23/15 14:09) ----- 70 % 5 FOLD TONY ----- Meeting Notes (9/23/15 14:38) ----- TONY TONY TONY 10.24.16

Factor: Caregivers ----- Meeting Notes (9/23/15 14:09) ----- YOUR FATHER.... ----- Meeting Notes (9/23/15 14:38) ----- MARY MARY MARY 10.24.16

Factor: Caregivers ----- Meeting Notes (9/23/15 14:09) ----- YOUR FATHER.... ----- Meeting Notes (9/23/15 14:38) ----- MARY MARY MARY 10.24.16

Factor: Mobile Users ----- Meeting Notes (9/23/15 14:09) ----- YOUR FATHER.... ----- Meeting Notes (9/23/15 14:38) ----- MARY MARY MARY 10.24.16

Factor: Mental Health ----- Meeting Notes (9/23/15 14:09) ----- FREUD JAMA NOTES BECOMING PART OF THE THERAPY VIRGINIA MASON, BIDMC, U WASH, 10.24.16

----- Meeting Notes (9/23/15 14:09) ----- 20 000 INVITED ONE YEAR NOW LOOK!!!! 10.24.16

About OpenNotes Supported by major combined grant from four leading foundations “…a remarkably simple way to substantially improve health care by fueling transparency and communication…a ‘must-have’ for tool for everyone…” Media Statement, December 15, 2015 ----- Meeting Notes (9/23/15 14:09) ----- 20 000 INVITED ONE YEAR NOW LOOK!!!! 10.24.16