Catherine M. DesRoches is an associate professor of medicine at Harvard Medical School and a distinguished health services researcher with expertise in emerging trends in health care delivery. She came to OpenNotes from Mathematica Policy Research where she was a senior fellow studying the use of electronic health records by hospitals and physicians; the effect of health care organizations on physician clinical practice; physician capacity to provide coordinated patient-centered care; and primary care workforce issues. Previously, she worked as a research scientist and project director for the Harvard T.H. Chan School of Public Health, and has held faculty positions at Vanderbilt University, Simmons College of Social Work, and Harvard Medical School.
DesRoches is a graduate of the School of Public Health at the University of Massachusetts, and the Joseph P. Mailman School of Public Health at Columbia University where she received her doctoral degree.
Q. What inspired the creation of OpenNotes?
OpenNotes, which started as a pilot project in 2010, was built on the foundational idea that there shouldn’t be a wall between patients and clinicians when it comes to information. Sharing medical records, including the clinician’s medical notes, levels the playing field and empowers patients to fully participate in their own care.
With OpenNotes, more than 27 million patients at more than 170 health care organizations in the United States have access to their notes.
Q. OpenNotes is sometimes described as a “movement.” What does that mean exactly, and how does it differ from a product?
OpenNotes is not a company, an electronic health records (EHR) vendor, or a cloud server full of clinical notes. We’re simply advocates for clinical transparency. While we are sometimes called a movement, that’s what we aspire to become. A movement has a life of its own, and we hope our work with health care organizations, patients and providers makes the cultural shift in health care that is needed to turn transparency into a true movement.
Q. What are a few of the key benefits for patients and providers?
When a patient goes to see a doctor, they often remember only about half of what the doctor says. And as visits become more stressful, the proportion remembered goes down significantly. In fact, some of the things patients remember are even incorrect. Having your clinician’s notes available makes it easier to focus on the visit without the stress of having to remember everything the doctor says, and provides a helpful reminder of what was discussed. Patients who read their notes say they feel more in control of their health and have a better understanding of their care plan. These notes also help patients understand why medications are prescribed and when they’re supposed to take them.
We also see a safety impact where patients are able to catch mistakes in their notes. Things like family history can be wrong, symptoms not correctly described, or the care plan incorrect.
For clinicians, the benefits are about improving the patient relationship. Patients report higher levels of trust knowing that their records are available, even if they’re not reading the notes. Beyond that, doctors who have participated report little change in workload, and patients overwhelmingly approve of note sharing as a practice.
Q. How have you worked with QIN-QIOs to help them leverage OpenNotes in their quality improvement work?
Right now, we’re working to figure out the best way to quantitatively measure what success looks like for patients and clinicians using OpenNotes. We’ve had a lot of qualitative success, but we’re looking to QIN-QIOs to help us understand what kind of data we need to specify those measurements.
Currently, Stratis Health—a member of the Lake Superior Quality Innovation Network-Quality Improvement Organization (QIN-QIO), which serves Michigan, Minnesota and Wisconsin—is supporting the spread of OpenNotes in Minnesota. Stratis Health has gathered information regarding the current status of sharing visit notes in Minnesota’s health care systems and organizations, and has made presentations to multiple audiences regarding the spread of OpenNotes around Minnesota. They shared this information through a national QIN call, so CMS’s quality improvement catalysts in the field became aware of how OpenNotes can enhance patient engagement and drive better care. We look forward to working with them and other QIN-QIOs in the near future.
Q. Anything else you would like QIO News readers to know?
As we continue to develop ways to measure the effects of OpenNotes, we welcome advice from any groups already doing that kind of work. We would love to take what’s happening and come up with a set of measures that an organization could use to measure relevant outcomes.