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This morning the New England Journal of Medicine released the latest publication about OpenNotes. The news: an innovative pre-visit form created for the “OurNotes” study has been released before the study is completed, for other providers to use to improve televisits during the pandemic. To access the form on the OpenNotes COVID-19 page shown above, click here.

The paper, Covid-19 as Innovation Accelerator: Cogenerating Telemedicine Visit Notes with Patients, describes a questionnaire that I myself got to use just last week in preparation for my annual visit with my PCP, SPM chair Dr. Danny Sands. I always try to be an engaged patient, but I found it was made easier by being given a structured way to prepare for my visit. So I can personally vouch for the usefulness of this approach, and I’m thrilled that it’s basically being made “open source” – they’re pre-releasing it for anyone to use … and expand and improve.


We’ve often blogged about OpenNotes, the practice of patients having access to what their providers write in the record after a visit – your so-called “visit notes.” OpenNotes goes back ten years, to when SPM co-founder Dr Danny Sands and I were guinea pigs in the very first OpenNotes study. (There are scores of OpenNotes papers now.)

The value of this questionnaire is amplified by the urgent need for televisits caused by the COVID-19 pandemic. It spotlights two different things that are important to patient engagement:

  • Using technology to improve care (including access to visits in trying circumstances)
  • the importance of pre-visit preparation …. which in turn requires staying on top of your issues between visits (the so-called “interval history”).

The featured graphic at top of this post is from the OpenNotes COVID-19 page, which includes a link to the downloadable form along with other advice – including staying informed between visits, and the world’s most comprehensive guide on how to stay safe during the pandemic. :-)

Here’s how it’s played out

One of my core principles for better care through patient engagement has always been “Make it easier to do the right thing.” Later I learned that this is also a core principle of behavioral economics, except they call it “choice architecture.” I speak from experience (my visit last week) when I say it works.

At bottom is Appendix 1 from the article, including both a patient’s and physician’s responses and the empty form itself (at the end).

Please think about this, in the context of your own care visits. Do you think back to what was discussed back then, and how it’s gone in the interval?

The combination of OpenNotes from the prior visit, and this questionnaire for the upcoming one, underscores how much more efficient and effective this visit’s time can be, when you spend it on actually addressing the progress of your issues, in continuity with your history. (I confess that there are times when I’ve forgotten to bring something up during a visit. Even if I handle it later in email, it’s an imposition on the provider’s time – and it probably won’t end up in the visit notes for next time!  I hate being the cause of a dropped ball, and this way of structuring a visit helps.)

The questionnaire arose as part of the OurNotes project

Some people thought OpenNotes was mind-blowing (patients reading doctor stuff???), but OurNotes takes it to the next level:

OurNotes: Explore the effects of notes co-produced by patients and clinicians working together, with the goal of improving health care value and patient safety. Pilot experiences with OurNotes are already highly promising, with both patients and clinicians signaling improved and more efficient care.

It’s a research project that’s been underway since 2017. The study’s not completed yet, so it’s a Big Deal in academic circles that the questionnaire is being released for anyone to use. Please spread the word – share that article and this post.

More about OpenNotes

OpenNotes is an international movement committed to spreading the availability of open visit notes and studying the effects. We believe that providing ready access to notes can empower patients, families, and caregivers to feel more in control of their healthcare decisions, and improve the quality and safety of care.

Things will never be the same

Many are saying things will never be the same after COVID-19 (if it ever ends), and I imagine that’s especially try for medical visits. Insurance is FINALLY paying docs for televisits (at last!!), and I’ve heard nothing but positive things about telehealth visits recently.

But think, too – telehealth time slots force us all to stick to a schedule, but is there any reason not to use this approach regardless of setting?  Seems to me it’s the way of the future.  Stay tuned.


Appendix 1
A Patient’s Pre-Visit Electronic Form and the Doctor’s Response

OurNotes pre-visit electronic form submitted by a patient: 

How have you been since your last visit? ← this section is the so-called “interval history”
BP has been pretty good: Feb 24 118 / 78, Mar 7 108/78, Mar 18 114/78. I was not feeling well all of Jan and Feb, cough/very low energy. Eventually got worse with fever, chills and came in – tested positive for flu. Chest X-ray was OK. Got Tamiflu. Feel much better now. BTW: I had been coughing for about 6 months, maybe more. Originally thought it was connected to meds, but I don’t cough at all now.

What are the most important things you would like to discuss at your visit?
is it possible to still get a flu shot?
should I get my potassium level checked?
renew prescriptions

Doctor’s response: (her note to other docs about this)

Day 1 of Telemedicine! Overwhelmed with trying to fit all the contents of a usual office visit into the time allotted, I was thrilled to see that one of my patients had completed her OurNotes entry! Because of this, I was able to “walk into” the visit with confidence in what lay ahead. I knew what her concerns were and what the focus should be. We had plenty of time to get to her “list” and also to my list of routine health care maintenance issues…and to chat about the COVID crisis and how we were each coping. What a difference from the other visits into which I “walked” unprepared! Emphasis added


Figure 1.  Pre-Visit Form

How have you been since your last visit?
For example, have you had any new symptoms, health worries, or life changes?  If possible, read your provider’s last opennote on PatientSite and tell us what has happened since then.
2,000 character limit (about 300 words)

What are the most important things you would like to discuss at your visit?  (List up to 3)
300 character limit  (about 50 words)
1.
2.
3.

If possible, please review your medication list in PatientSite. Is the list correct?
  If yes, go to the next question.
If no, what is wrong or missing?
Find your medication list in PatientSite by going to “Records” on the left side of your screen, then click the “Meds” tab near the top.
300 character limit

Do you need any prescriptions renewed?
If no, go to the next question.

If yes, which medication(s)?
 300 character limit

Which pharmacy should the renewal prescriptions go to?
300 character limit

If you have equipment at home, please fill in as many of the following measurements as you can.
If you can’t fill this in, don’t worry.
Weight
Temperature
Blood pressure
Heart rate
Blood glucose 

Thank you for helping us prepare for your visit!

 

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