Gerard Macda, Fossa Alan, Folcarelli Patricia H, Walker Jan, Bell Sigall K
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.
Department of Health Care Quality, Beth Israel Deaconess Medical Center, Boston, MA, United States.
J Med Internet Res. 2017 Jul 14;19(7):e237. doi: 10.2196/jmir.7212.
Patients are increasingly asking for their health data. Yet, little is known about what motivates patients to engage with the electronic health record (EHR). Furthermore, quality-focused mechanisms for patients to comment about their records are lacking.
We aimed to learn more about patient experiences with reading and providing feedback on their visit notes.
We developed a patient feedback tool linked to OpenNotes as part of a pilot quality improvement initiative focused on patient engagement. Patients who had appointments with members of 2 primary care teams piloting the program between August 2014-2015 were eligible to participate. We asked patients what they liked about reading notes and about using a feedback tool and analyzed all patient reports submitted during the pilot period. Two researchers coded the qualitative responses (κ=.74).
Patients and care partners submitted 260 reports. Among these, 98.5% (256/260) of reports indicated that the reporting tool was valuable, and 68.8% (179/260) highlighted what patients liked about reading notes and the OpenNotes patient reporting tool process. We identified 4 themes describing what patients value about note content: confirm and remember next steps, quicker access and results, positive emotions, and sharing information with care partners; and 4 themes about both patients' use of notes and the feedback tool: accuracy and correcting mistakes, partnership and engagement, bidirectional communication and enhanced education, and importance of feedback.
Patients and care partners who read notes and submitted feedback reported greater engagement and the desire to help clinicians improve note accuracy. Aspects of what patients like about using both notes as well as a feedback tool highlight personal, relational, and safety benefits. Future efforts to engage patients through the EHR may be guided by what patients value, offering opportunities to strengthen care partnerships between patients and clinicians.
患者越来越多地索要自己的健康数据。然而，对于促使患者使用电子健康记录（EHR）的因素，我们却知之甚少。此外，缺乏以质量为重点的机制让患者对自己的记录发表意见。
我们旨在更多地了解患者阅读就诊记录并提供反馈的体验。
作为一项以患者参与为重点的试点质量改进计划的一部分，我们开发了一个与“开放笔记”（OpenNotes）相关联的患者反馈工具。2014年8月至2015年期间预约了参与该计划试点的两个初级保健团队成员的患者有资格参与。我们询问患者对阅读记录以及使用反馈工具的看法，并分析了试点期间提交的所有患者报告。两名研究人员对定性回复进行编码（κ = 0.74）。
患者和护理伙伴提交了260份报告。其中，98.5%（256/260）的报告表明报告工具很有价值，68.8%（179/260）的报告突出了患者对阅读记录和“开放笔记”患者报告工具流程的喜爱之处。我们确定了4个主题来描述患者对记录内容的重视点：确认并记住后续步骤、更快获取信息和结果、积极情绪以及与护理伙伴分享信息；还有4个关于患者使用记录和反馈工具的主题：准确性和纠正错误、伙伴关系和参与度、双向沟通和强化教育以及反馈的重要性。
阅读记录并提交反馈的患者和护理伙伴表示参与度更高，并且希望帮助临床医生提高记录的准确性。患者对使用记录和反馈工具的喜爱之处突出了个人、关系和安全方面的益处。未来通过电子健康记录让患者参与的努力可能会以患者重视的内容为指导，提供加强患者与临床医生之间护理伙伴关系的机会。
