The Importance of Visit Notes on Patient Portals for Engaging Less Educated or Nonwhite Patients: Survey Study

Area of Science:

• Health Informatics
• Patient Engagement
• Health Disparities

Background:

• OpenNotes is a national initiative providing patients access to their clinical visit notes.
• While OpenNotes can enhance patient engagement, its impact on vulnerable populations remains under-researched.

Purpose of the Study:

• To investigate the perceived importance of clinicians' visit notes for nonwhite and less educated patients.
• To assess how reading visit notes influences patient understanding, decision-making, and overall engagement in their healthcare.

Main Methods:

• A survey was administered to patients with portal access and available visit notes at an urban academic medical center.
• The survey assessed the importance of reading notes for understanding health conditions, feeling informed, comprehending the provider's thought process, remembering the care plan, and making care decisions.
• Data were analyzed using logistic regression, stratifying by education level, race/ethnicity, and self-reported health status.

Main Results:

• Less educated and nonwhite patients reported higher importance of notes for feeling informed, remembering the care plan, and making decisions compared to their more educated and white counterparts.
• Patients with lower education were nearly three times as likely to find notes extremely important for engagement (OR 2.9).
• Nonwhite patients were twice as likely to report notes as extremely important for engagement (OR 2.0-2.2).

Conclusions:

• Less educated and nonwhite patients attribute significant value to reading clinical notes, particularly for understanding their health and engaging in care.
• Facilitating access to visit notes may be a key strategy to improve healthcare engagement among historically underserved populations.
• Transparent access to clinical notes can empower vulnerable patient groups and reduce health disparities.