The OpenNotes intervention and results of baseline surveys have been described previously (1 (link), 2 (link)). Primary care physicians affiliated with an urban hospital (Beth Israel Deaconess Medical Center [BIDMC] in Boston, Massachusetts), predominantly rural practices (Geisinger Health System [GHS] in Pennsylvania), and an urban safety-net hospital (Harborview Medical Center [HMC] in Seattle, Washington) were invited to offer their patients electronic access to office notes. Patients at BIDMC and GHS had experience with established electronic portals, whereas those at HMC did not. Eligible doctors and their patients were surveyed about expectations before initiation. During the intervention, participating patients were notified electronically when office notes were signed and ready for viewing.
All PCPs were eligible except for housestaff, fellows, and those in BIDMC community practices without portal-compatible records. Participating doctors’ names were posted on the study Web site (7 ). At BIDMC and GHS, all patients who used portals were invited electronically to participate in the intervention unless specifically excluded by the PCP (158 at BIDMC and 139 at GHS). Patients at HMC were invited individually, excluding 1023 with primarily major mental illness, substance abuse, or both (1 (link), 2 (link)).
The names of doctors who left the study were removed from the Web site, and their participating patients were notified through secure messages before access was terminated. Patients of doctors who left the practice were notified according to each site’s policy; access to existing notes was retained at BIDMC and HMC but lost at GHS. At all sites, patient access to notes was terminated immediately on request to withdraw from the study.
All PCPs were eligible except for housestaff, fellows, and those in BIDMC community practices without portal-compatible records. Participating doctors’ names were posted on the study Web site (7 ). At BIDMC and GHS, all patients who used portals were invited electronically to participate in the intervention unless specifically excluded by the PCP (158 at BIDMC and 139 at GHS). Patients at HMC were invited individually, excluding 1023 with primarily major mental illness, substance abuse, or both (1 (link), 2 (link)).
The names of doctors who left the study were removed from the Web site, and their participating patients were notified through secure messages before access was terminated. Patients of doctors who left the practice were notified according to each site’s policy; access to existing notes was retained at BIDMC and HMC but lost at GHS. At all sites, patient access to notes was terminated immediately on request to withdraw from the study.
