JMIR Publications

ABSTRACT

Background:

On December 13, 2016, congress enacted the 21st Century Cures Act that contained the Final Rule Mandate, a policy commonly known as OpenNotes. Beginning April 5, 2021, healthcare systems have been required to give patients access to all the health information in their electronic medical records, including clinician notes, “without delay” and without charge.

Objective:

To assess clinicians’ attitudes and experiences with OpenNotes after the mandated implementation of the 21st Century Cures Act.

Methods:

This cross-sectional survey study was conducted between June 10, 2021, to August 15, 2021 at the University of Kansas Health System, a large academic medical center in Kansas City, Kansas. Participants included clinicians currently employed by the health system, including resident and attending physicians, physician assistants, nurse practitioners, and critical care and emergency medicine registered nurses.

Results:

A total of 1,574 attending physicians, physician assistances, and nurse practitioners, as well as 506 critical care and emergency medicine nurses, were sent invitations; 538 (34.2%) and 72 (14.2%) responded, respectively. Four of 609 resident physicians (response rate not applicable) responded. The majority of respondents were attending physicians (402/614, 65.5%) and within the department of internal medicine (160/614, 26.1%). Most agreed that sharing visit notes was a good idea (355/613, 58%) and that it is important to speak to the patients prior to them accessing their records (433/613, 70.6%). Those who agreed that sharing visit notes is a good idea tended to view the practice as a useful tool for engaging patients (Agree, 139/355, 39.2%; Somewhat Agree, 161/355, 45.4%; P<.001) and experience no change in the clinical value of their notes (326/ 355, 91.8%; P<.001). Those who disagreed (or were neutral) tended to not encourage patients to read their notes (235/258, 91.1%; P<.001) and were more likely to experience a change in their charting practice (168/257, 65.4%; P<.001) and increased time charting (99/258, 38.4%; P<.001).

Conclusions:

The experiences of clinicians outlined in this study may be useful to understand what clinicians at similar institutions experienced after the initial implementation of the Cures Act and to determine how to best prepare clinicians for future policy implementation.