AMDIS: OpenNotes, social media are patient engagement ‘sweet spots’

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BOSTON—Is it a good idea to let patients see clinician notes? Bradley Crotty, MD, MPH, investigator, clinical informatics at Beth Israel Deaconess Medical Center in Boston, answered a resounding yes at a talk exploring OpenNotes and social media as patient engagement tools at the AMDIS Fall Symposium.

At a time when healthcare organizations need to close the “big gap” in achieving efficient accountable care in managing populations, giving patients the reins over their health through use of OpenNotes and social media show promise, Crotty says.

Crotty broke down patient engagement challenges into three categories: information asymmetry, integration and reinforcement.

Data from a year-long OpenNotes demonstration project, in which clinician notes were accessible to patients at Beth Israel, Geisinger Health System in Danville, Penn., and Harborview Medical Center in Seattle, Wash., revealed strong patient engagement that helped tackle these three challenges. Data found:

  • 84 percent of Beth Israel patients, 82 percent of Geisinger patients and 47 percent of Harborview patients opened at least one of their notes
  • 20 to 42 percent of patients reported sharing their notes with someone else
  • 60 to 87 percent of patients reported doing better with taking their medications as prescribed

"These are encouraging results,” he said.

While 77 to 87 percent of patients felt more control of their care, some privacy concerns lingered, Crotty said. Between 26 and 36 percent of patients expressed privacy worries, but he noted that the level of concern measurably dropped the longer the project was in operation.

Due to the success of the demonstration, OpenNotes is moving towards implementation. Beth Israel Deaconess is rolling out OpenNotes in orthopedic care across the system. In the meantime, Crotty said OpenNotes implementation use is under consideration in other types of environments such as specialty environments, pediatric clinics and psychiatrist offices. Also, Crotty said there is exploration whether OpenNotes should incorporate a feedback loop so patients can directly answer questions verifying their comprehension of the clinical notes.

Social media also can play a role in engaging patients and their behavior, Crotty said.

Trends show that individuals increasingly use social media to navigate health issues, with 80 percent of users seeking health information online, 23 percent of individuals following friends’ health experiences online and 9 percent of consumers joining online health-related support groups.

Some online services enforce behavioral change through creative means, by having consumers promise to adhere to lifestyle goals or else face consequences (i.e., make a donation to an organization he or she doesn’t support).

More and more hospitals and clinics are launching Facebook pages to disseminate health information, but Crotty stressed that monitoring must be in place to ensure users do not use the platform for clinical encounters.

All in all, Crotty said he is “bullish" about sharing information, whether through networking, microblogging or sharing clinical innovation with patients. OpenNotes and social media are the “sweet spots” that encourage better patient engagement, he said.