In the survey done at the end of the study, 20% of the participating physicians indicated they would not want to continue using the OpenNotes method, but when their commitment ended, not one followed through on those wishes. After reviewing the results of the study, the leadership at BIDMC, including all the clinical chiefs, voted unanimously to expand the OpenNotes program, Walker says. By the end of this summer, it will be rolled out to the 50,000 patients who are registered on BIDMC's online, she says.
Geisinger's big OpenNotes expansion, scheduled for April 2013, netted 585 doctors who volunteered to go live, up from the 25 doctors who participated in the trial. "We have some folks who've also embraced it very wholeheartedly, including some of our surgeons, which I'm thrilled about," says Jonathan Darer, MD, chief innovation officer at Geisinger, a system which serves more than 2.6 million residents throughout 44 counties in central and northeastern Pennsylvania.
Leading up to this spring's expansion, Darer gave 30–40 internal presentations to departments and small groups, listening to concerns. "There are a couple of themes that people express, and I can head those off with a presentation and try to help them understand how we're going to manage some of the more sticky points," Darer says. "For example, everybody's got somebody in their clinic who's, you know, complicated, emotionally—family issues, whatever it is. I say, 'Don't worry. We give the physicians the ability to exclude patients.' "
Indeed, Geisinger's study didn't find the unanimous good patient vibes found at BIDMC. Two to eight percent of patients "felt some kind of negative impact," Darer says. "Some felt offended, some felt more worried. Giving the physicians the ability to exclude patients, just like they do with any medication or any medical treatment, based upon their good judgment, is appropriate."
Nevertheless, at Geisinger, 87% of the patients who participated in the study read every single note generated by caregivers, Darer says. "Eight-seven percent of patients doing anything is just remarkable, and all we did was send them a little note," he says. Even more remarkable, 33% of the patients had a high school education or less. "Some of the language or terminology in a physician's progress note can be pretty challenging for somebody to read, yet there's incredible engagement with the material, people reading these notes, or at least opening them," he says. The data also showed patients repeatedly reading their clinical notes, and 20% of them reported sharing their notes with someone else.