How will notes change? An Exploratory Study of the Effect of OpenNotes on Oncology Documentation (Preprint)

BACKGROUND In 2010, OpenNotes began as a concept for patients to track their medical information through online patient portals. The goal of OpenNotes is to promote patient access to doctor’s visit notes and improve transparency and communication between clinicians and patients. OBJECTIVE To determine if implementing OpenNotes at a hematology/oncology practice has changed providers’ documentation style, we assessed the length and readability of clinicians’ notes before and after the OpenNotes adoption at Beth Israel Deaconess Medical Center, Boston, MA. METHODS We analyzed 143,888 notes from 60 hematology/oncology clinicians from January 1, 2012, to September 1, 2016; before and after the OpenNotes debut at Beth Israel Deaconess Medical Center. We measured the effect of OpenNotes on provider’s documentation styles by analyzing character length, number of addenda, note entry mode (dictated vs typed) and note readability as measured using five different readability formulas before and after the introduction of OpenNotes. RESULTS Mean length of progress notes increased from 6174 to 6648 characters after the introduction of OpenNotes (P<0.001). There was also an increase from 1435 to 1597 in mean character length of “Assessment and Plan” section of progress notes (P<0.001). Average Grade Level Readability of progress notes decreased from 11.50 to 11.33 and their overall readability improved (P=0.01). There were no statistically significant changes in the length or readability of “Initial Notes” or Letters, inter-doctor communication, nor in the modality of the recording of any kind of note. CONCLUSIONS After the implementation of OpenNotes, progress notes and assessment and plan sections became both longer and easier to read. This suggests that clinician documenters are responding to the pressures of the OpenNotes environment with changes that are positive for patients.