How NYC Health + Hospitals boosted physicians' use of OpenNotes

NYC Health + Hospitals experienced an 11-fold increase in its number of providers using OpenNotes, an international movement that aims to encourage providers to share clinical notes with patients, after the New York City-based health system integrated the service with its Epic EHR.

Dave Chokshi, MD, chief population health officer at NYC Health + Hospitals, published a case study on the hospital's OpenNotes initiative in the New England Journal of Medicine.

Between February 2017 and October 2018, the number of NYC Health + Hospitals providers sharing clinical notes grew from 157 to 1,758. Collectively, the providers shared 129,579 notes with 23,282 patients during the 20-month time period. The health system's population health office launched OpenNotes among its first wave of facilities transition to the Epic EHR in February 2017. The sites undergoing the transition included three hospitals and their affiliated ambulatory care sites, at which NYC Health + Hospitals enabled default note sharing via Epic's patient portal MyChart.

To analyze OpenNotes adoption, NYC Health + Hospitals developed a monthly report based off existing data fields in MyChart. The data comprised three categories: patient/provider identifiers, actions taken in Epic and demographic data.

Data cascades became an integral part to how the health system illustrated OpenNotes performance. NYC Health + Hospitals created a digital dashboard that featured the data cascades and key process and outcome metrics, which the research team circulated regularly during EHR implementation to connect with clinical providers participating in OpenNotes. 

NYC Health + Hospitals also implemented evidence-based behavioral techniques, such as Easy, Attractive, Social and Timely measures to impact behavior change. These included enabling self-sign up to increase patient portal enrollment and making notes easier to find by adding a new button for viewing notes on the MyChart homepage that features instructional banners.

The health system's population health office partnered with its IT team, marketing and communication teams and behavioral sciences teams for the project. This helped to round out the patient engagement initiative and successfully increase patient outreach.

"As health systems consider how to implement patient-engagement initiatives, it is critical to assemble interdisciplinary teams with the right mix of skill sets, including some not included in traditional hospital administration and population health management," the study authors concluded.

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