Stanford Medicine, Palo Alto, California, United States.
Stanford Children's Health, Palo Alto, California, United States.
Appl Clin Inform. 2021 Jan;12(1):76-81. doi: 10.1055/s-0040-1721781. Epub 2021 Feb 10.
OpenNotes, the sharing of medical notes via a patient portal, has been extensively studied in adults but not in pediatric populations. This has been a contributing factor in the slower adoption of OpenNotes by children's hospitals. The 21st Century Cures Act Final Rule has mandated the sharing of clinical notes electronically to all patients and as health systems prepare to comply, some concerns remain particularly with OpenNotes for pediatric populations.
After a gradual implementation of OpenNotes at an academic pediatric center, we sought to better understand how pediatric patients and families perceived OpenNotes. This article presents the detailed steps of this informatics-led rollout and patient survey results with a focus on pediatric-specific concerns.
We adapted a previous OpenNotes survey used for adult populations to a pediatric outpatient setting (with parents of children <12 years old). The survey was sent to patients and families via a notification email sent as a standard practice after a clinic visit, in English or Spanish.
Approximately 7% of patients/families with access to OpenNotes read the note during the study period, and 159 (20%) of those patients responded to the survey. Of the survey respondents, 141 (89%) of patients and families understood their notes; 126 (80%) found the notes always or usually accurate; 24 (15%) contacted their clinicians after reading a note; and 153 (97%) patients/families felt the same or better about their doctor after reading the note.
Although limited by relatively low survey response rate, OpenNotes was well-received by parents of pediatric patients without untoward consequences. The main concerns pediatricians raise about OpenNotes proved to not be issues in the pediatric population. Our results demonstrate clear benefits to adoption of OpenNotes. This provides reassurance that the transition to sharing notes with pediatric patients can be successful and value additive.
通过患者门户共享病历的开放医嘱（OpenNotes）在成人中得到了广泛研究，但在儿科人群中却没有。这也是儿童医院采用 OpenNotes 速度较慢的一个因素。《21 世纪治愈法案》最终规则要求向所有患者电子共享临床记录，随着医疗系统准备遵守这一规定，一些问题仍然存在，尤其是在儿科人群中使用 OpenNotes 的问题。
在学术型儿科中心逐步实施 OpenNotes 后，我们试图更好地了解儿科患者和家属对 OpenNotes 的看法。本文介绍了这一以信息学为导向的实施过程的详细步骤以及患者调查结果，重点关注儿科特有的问题。
我们将先前用于成人的 OpenNotes 调查进行了改编，使其适用于儿科门诊环境（包括 12 岁以下儿童的家长）。调查通过在就诊后作为标准操作流程发送的通知电子邮件发送给患者和家属，可选择英文或西班牙文。
在研究期间，大约 7%有机会阅读 OpenNotes 的患者/家属阅读了医嘱，其中 159 名（20%）患者对调查做出了回应。在调查应答者中，141 名（89%）患者和家属理解他们的医嘱；126 名（80%）认为医嘱始终或通常准确；24 名（15%）在阅读医嘱后联系了他们的临床医生；153 名（97%）患者/家属在阅读医嘱后对医生的感觉与之前相同或更好。
尽管调查应答率相对较低，但 OpenNotes 受到儿科患者家长的欢迎，没有产生不良后果。儿科医生对 OpenNotes 提出的主要担忧在儿科人群中并不是问题。我们的结果表明，采用 OpenNotes 具有明显的益处。这证明了向儿科患者共享医嘱可以成功并具有附加价值。
