Homer Chin: Vendor support for OpenNotes a 'necessary but insufficient condition' [Q&A]

The OpenNotes project, which aims to better engage patients by allowing them real-time access to their doctor's clinical notes, continues to evolve and expand. For instance, in December, four organizations, including the Gordon and Betty Moore Foundation and the Robert Wood Johnson Foundation, provided a $10 million infusion to the effort to help it grow to 50 million patients nationwide. Additionally, last month, the College of Healthcare Information Management Executives and OpenNotes announced a partnership to accelerate information sharing between patients and providers as part of President Barack Obama's Precision Medicine Initiative.

Such expansion, however, has not always been easy, and many efforts are works in progress, according to Homer Chin, a physician champion for the Northwest OpenNotes Consortium and former associate medical director for medical informatics at Kaiser Permanente Northwest.

At the Healthcare Information and Management Systems Society's annual conference in Las Vegas last week, Chin and Amy Fellows, executive director of We Can Do Better, an organization that looks to improve patient engagement, discussed with FierceHealthIT the program's current direction and challenges.

FierceHealthIT: What are some of the current challenges OpenNotes faces?

Homer Chin: One of the necessary but insufficient conditions is to get the vendor to be able to support the functionality, so one of our goals is to talk to all the vendors and make sure that they have the functionality to support it.

Vendors can build the functionality in different ways, so we're putting together a best practices guide; we can assist them and advise them as to how to implement OpenNotes, so we're making the rounds.

Epic, right now, certainly seems to have the most robust functionality to support OpenNotes; they've built it into their base products, so in 2015, if you implement Epic, you can just configure the system and then you've got OpenNotes. Cerner also has pretty robust functionality, but there are still some things that they're working to do. There are a number of organizations that have Cerner implemented with OpenNotes.

FHIT: How many vendors are you working with?

Chin: We're targeting the top eight or so vendors, and then there also are these other vendors of patient portals that are sort of vendor-agnostic--they say "yes, we're doing a portal functionality, but we work with any number of vendors." We're starting to take a look at them, as well, to see what sort of market share they have, which vendors they connect to, how good is their functionality, etc.

One of the things that we haven't fully explored is that many patients will have electronic records in multiple systems. Right now, they have one portal for this system, another portal for another system; the question is, what is the functionality to integrate that information from the different health systems? That's still a very nascent area. There are vendors that are doing significant work in that area, but it's still early on.

FHIT: What are some of the more notable patient results that have come about from use of OpenNotes?

Chin: Patient responses have been really positive. Up to three quarters of providers have noted better patient engagement, better patient understanding of their health conditions and that patients are more likely to take medications as prescribed.

In terms of hard data, the only piece that we have right now is a paper published last fall that shows patients on OpenNotes have better blood pressure control.

FHIT: What are OpenNotes' forthcoming plans?

Amy Fellows: As far as the evolution of the program goes, it started primarily with primary care, and then other specialties have been added on. There are a few mental health pilots happening. There's inpatient pilots happening. For our group, I had a lot of fear that once providers tried it, they'd stop coming together and then we wouldn't be able to have their knowledge shared with smaller practices that are starting to come along. But they keep coming because they want to know on the national scene what's happening with mental health, what's happening with inpatient.

One of our groups, the Vancouver Clinic in Washington, allows adolescents to view their notes.

Also on the patient side, we're really going to be taking a look at vulnerable populations, people who aren't English speakers, those who have health literacy issues, those kinds of things. We really want to make this transparency available for everybody, not just the middle class.

Chin: Our philosophy is, the more transparency, the better. Labs, for the most part, are being shared. It would be nice to fully share radiology results, pathology results, the entire medical record. The idea is to get outside of the brick-and-mortar paradigm that we have for medical care where people need to be seen by their clinician.

FHIT: Can you elaborate on Vancouver Clinic's initiative to share records with adolescents?

Chin: For patients ages 0 to 12, the parents have proxy access. And then once the patient turns 13, they give the patient access. The patient then has the right to give their parents proxy access, if they want.

One of the best practices we recommend is to give a physician or a provider the option for a particular visit--if there's something particularly sensitive, for instance--to click a button to say "don't share this particular note."

Some organizations, what they do is, 0 to 12, they default share, and then from 13 to 18, the default is don't share, but the clinician can click a button to say "share this note."

We're still learning ourselves about what other organizations are doing.

Editor's Note: This interview has been condensed for content and clarity.

Read more on