Patients Contributing to their Visit Notes: A Mixed Methods Evaluation of Pilot Experiments with OurNotes (Preprint)

BACKGROUND Patients are uniquely positioned to document both their subjective experiences and goals for a medical encounter. OBJECTIVE To assess the effects of 12-month pilot interventions of co-generated visit notes. METHODS Patients at 6 primary care practices in 4 academic health centers were asked to provide unstructured interval histories and an agenda for discussion prior to a scheduled primary care visit. Clinicians were invited to incorporate these submissions into visit notes, thereby generating “OurNotes.”174 providers participated, and 1,962 patients submitted at least 1 pre-visit form. RESULTS 76 providers (44%) and 525 patients (27%) responded; 74 providers and 321 patients remembered the OurNotes forms and answered survey questions. Patients found the history (81%) and agenda (89%) questions not difficult to answer; >90% thought sending answers before the visit a good idea; 69% thought the questions helped them prepare; we found no differences for patients reporting chronic conditions. Patients wanted to learn how to write better answers and to know whether their submissions were read. Clinicians thought interim histories (93%) and agendas (97%) a good idea; 69% usually/always incorporated them into notes; 37% thought they saved time in visit length; 53% reported no change. They suggested improving notifications when forms arrived, simplifying inserting submissions into notes, and teaching patients how to prepare submissions. All sites decided to continue with OurNotes after the pilots. CONCLUSIONS Overall, both patient and clinician respondents viewed the pilot interventions positively and encouraged further development, and each site chose to continue the practice. CLINICALTRIAL N/A