2. Cracking Open the Record Challenges and Best Practices of Implementation of the Patient Accessible Electronic Medical Record in a Residency Program Pam Pentin MD, UW PGY3 Resident Class: Elizabeth Allcut, Claire Ankuda, Katherine Ball, Sara Bowling, Nelson Chiu, Ben Goold, Lili Sperry, Alyce Sutko

3. Disclosures No disclosures

4. What if she is offended? It will take more time! How do I document her drug abuse There will be so many emails and phone calls It will just make him more anxious

5. Goals Anticipate provider and patient challenges to implementation of the patient accessible EMR Describe best practices for patient accessible EMR roll out based upon current literature and qualitative research Articulate strategies to teach residents to use patient accessible EMR

6. Methods Cross sectional study Recruited patients in the lobby of our clinic Phone interviews 2 weeks later

7. Results

8. 66% Of respondents had a positive view of their note

9. 27% Of respondents reported that they will discuss something in their note with their provider

10. 0 Respondents reported seeing anything unexpected

11. 100% Of respondents reported that they will continue to read their notes

12. Can other people read my note? I feel more connected with my doctor I did not realize my doctor wrote a note for each visit Oh, I should be taking my buproprion twice a day

13. Conclusions Patients like accessing their chart notes Promotes patient engagement in healthcare Our notes are not designed for patients

14. Limitations Pilot study Small sample size Fewer patients with EMR access than expected Selection criteria

15. Recommendations Expect that patients will read and like their notes Improve EMR interface Note language and format

16. Questions?

17. References 1. de Lusignan S, Mold F, Sheikh A, et al. Patients' online access to their electronic health records and linked online services: A systematic interpretative review. BMJ Open. 2014;4(9):e006021-2014-006021. doi: 10.1136/bmjopen- 2014-006021 [doi]. 2. 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(7):461-470. doi: 10.7326/0003-4819-157-7-201210020-00002 [doi]. 3. Delbanco T, Walker J, Darer JD, et al. Open notes: Doctors and patients signing on. Ann Intern Med. 2010;153(2):121-125. doi: 10.7326/0003-4819-153-2-201007200-00008 [doi]. 4. Dhanireddy S, Walker J, Reisch L, Oster N, Delbanco T, Elmore JG. The urban underserved: Attitudes towards gaining full access to electronic medical records. Health Expect. 2014;17(5):724-732. doi: 10.1111/j.1369- 7625.2012.00799.x [doi]. 5. Feeley TW, Shine KI. Access to the medical record for patients and involved providers: Transparency through electronic tools. Ann Intern Med. 2011;155(12):853-854. doi: 10.7326/0003-4819-155-12-201112200-00010 [doi]. 6. Feldman HJ, Walker J, Li J, Delbanco T. OpenNotes: Hospitalists' challenge and opportunity. J Hosp Med. 2013;8(7):414-417. doi: 10.1002/jhm.2052 [doi].

18. References 7. Ferreira A, Correia A, Silva A, et al. Why facilitate patient access to medical records. Stud Health Technol Inform. 2007;127:77-90. 8. Ferreira A, Cruz-Correia R, Antunes L, Chadwick D. Access control: How can it improve patients' healthcare? Stud Health Technol Inform. 2007;127:65-76. 9. Hanson JL, Stephens MB, Pangaro LN, Gimbel RW. Quality of outpatient clinical notes: A stakeholder definition derived through qualitative research. BMC Health Serv Res. 2012;12:407-6963-12-407. doi: 10.1186/1472-6963-12-407 [doi]. 10. Kahn MW, Bell SK, Walker J, Delbanco T. A piece of my mind. let's show patients their mental health records. JAMA. 2014;311(13):1291-1292. doi: 10.1001/jama.2014.1824 [doi]. 11. Leveille SG, Walker J, Ralston JD, Ross SE, Elmore JG, Delbanco T. Evaluating the impact of patients' online access to doctors' visit notes: Designing and executing the OpenNotes project. BMC Med Inform Decis Mak. 2012;12:32-6947-12-32. doi: 10.1186/1472-6947-12-32 [doi]. 811-819. doi: 10.7326/0003-4819-155-12-201112200-00003 [doi]. 12. Meltsner M. A patient's view of OpenNotes. Ann Intern Med. 2012;157(7):523-524. doi: 10.7326/0003-4819-157-7-201210020-00012 [doi].

19. References 13. Oster NV, Jackson SL, Dhanireddy S, et al. Patient access to online visit notes: Perceptions of doctors and patients at an urban HIV/AIDS clinic. J Int Assoc Provid AIDS Care. 2014. doi: 2325957414526783 [pii]. 14. Ross SE, Lin CT. The effects of promoting patient access to medical records: A review. J Am Med Inform Assoc. 2003;10(2):129-138. 15. Trossman S. OpenNotes initiative aims to improve patient-clinician communication, care. Okla Nurse. 2013;58(4):15. 16. Vodicka E, Mejilla R, Leveille SG, et al. Online access to doctors' notes: Patient concerns about privacy. J Med Internet Res. 2013;15(9):e208. doi: 10.2196/jmir.2670 [doi]. 17. Vogel L. OpenNotes project "levels the playing field" between doctors and patients. CMAJ. 2010;182(14):1497- 1498. doi: 10.1503/cmaj.109-3662 [doi]. 18. Walker J, Leveille SG, Ngo L, et al. Inviting patients to read their doctors' notes: Patients and doctors look ahead: Patient and physician surveys. Ann Intern Med. 2011;155(12):

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