Lessons Learned from OpenNotes Learning Mode and Subsequent Implementation across a Pediatric Health System.

Area of Science:

• Health Informatics
• Patient Engagement
• Pediatric Healthcare

Background:

• The 21st Century Cures Act promotes OpenNotes, enhancing patient and family involvement in healthcare.
• Pediatric health systems face unique challenges in balancing information sharing with adolescent confidentiality and safety.

Purpose of the Study:

• To document lessons learned during a 4-month trial (Learning Mode) of OpenNotes implementation in a pediatric health system.
• To evaluate strategies for improving information sharing while addressing confidentiality concerns.

Main Methods:

• A 4-month "Learning Mode" trial with educational prompts, a confidential note type, and a multidisciplinary feedback mechanism.
• Analysis of confidential notes, physician feedback cases, and note sharing proportions before and after default sharing.

Main Results:

• Physician note sharing increased from 1.3% to 88.4% after implementing default sharing.
• Sensitive information was identified in autopopulated fields and diagnoses.
• Clinician accuracy in selecting reasons for withholding notes improved with system redesigns.

Conclusions:

• OpenNotes offers significant potential for pediatric patient and family engagement.
• Targeted education and optimized electronic health record (EHR) designs are essential to prevent inappropriate disclosures and ensure patient safety.