Clinician Perspectives on Open Notes in Oncology Palliative Care: A Mixed-Methods Study

Area of Science:

• Health Informatics
• Palliative Care Research
• Oncology Practice

Background:

• The 21st Century Cures Act Interoperability and Information Blocking Rule (IBR) aims to increase health information transparency for patients.
• Limited evidence-based guidelines exist for health systems and clinicians implementing the IBR.
• Palliative care and oncology clinicians face unique challenges in IBR implementation.

Purpose of the Study:

• To explore clinician perspectives and experiences with the IBR in oncology and palliative care settings.
• To understand the nuances of clinician concerns and benefits related to the IBR.
• To identify specialty-specific challenges in IBR implementation.

Main Methods:

• Convergent parallel mixed-methods design.
• Surveys administered to clinicians.
• In-depth interviews with clinicians.

Main Results:

• Three key themes emerged: specialty-specific worries about potential harm, documentation adjustments due to the IBR, and the utility of shared clinical notes.
• Oncology clinicians expressed greater concern regarding the sensitivity of test results.
• Palliative care clinicians were more concerned about the sensitivity of information shared in family meetings and prognostic details.

Conclusions:

• Clinician experiences with the IBR are more complex than initially perceived.
• Specialty-specific considerations are crucial for effective IBR implementation.
• Further research is needed to identify best practices for maximizing benefits and minimizing harm during IBR rollout.