title: Patients learning to read their doctors' notes: the importance of reminders.
abstract: To examine whether patients invited to review their clinicians' notes continue to access them and to assess the impact of reminders on whether patients continued to view notes.
  
  
  
  We followed OpenNotes trial participants for 2 years at Beth Israel Deaconess Medical Center (BIDMC) and Geisinger Health System (GHS). Electronic invitations alerting patients to signed notes stopped at GHS after year 1, creating a natural experiment to assess the impact of reminders. We used generalized linear models to measure whether notes were viewed within 30 days of availability.
  
  
  
  We identified 14 360 patients (49 271 visits); mean age 52.2; 57.8% female. In year 1, patients viewed 57.5% of their notes, and their interest in viewing notes persisted over time. In year 2, BIDMC patients viewed notes with similar frequency. In contrast, GHS patients viewed notes far less frequently, a change starting when invitations ceased (RR 0.29 [0.26-0.32]) and persisting to the end of the study (RR 0.20 [0.17-0.23]). A subanalysis of BIDMC patients revealed that black and other/multiracial patients also continued to view notes, although they were overall less likely to view notes compared with whites (RR 0.75 [0.67-0.83] and 0.93 [0.89-0.98], respectively).
  
  
  
  As millions of patients nationwide increasingly gain access to clinicians' notes, explicit email invitations to review notes may be important for fostering patient engagement and patient-doctor communication.
  
  
  
  Note viewing persists when accompanied by email alerts, but may decline substantially in their absence. Non-white patients at BIDMC viewed notes less frequently than whites, although their interest also persisted.
authors.affiliation: Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA RAND Corporation, Santa Monica, CA, USA Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA jmafi@mednet.ucla.edu.
authors.forename: John N
authors.initials: JN
authors.lastname: Mafi
authors.affiliation: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Roanne
authors.initials: R
authors.lastname: Mejilla
authors.affiliation: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Henry
authors.initials: H
authors.lastname: Feldman
authors.affiliation: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Long
authors.initials: L
authors.lastname: Ngo
authors.affiliation: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Tom
authors.initials: T
authors.lastname: Delbanco
authors.affiliation: Department of General Internal Medicine, Geisinger Health System, Danville, PA, USA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Darer
authors.affiliation: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Wee
authors.affiliation: Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Jan
authors.initials: J
authors.lastname: Walker
mesh_terms: D000328:Adult; D015986:Confounding Factors, Epidemiologic; D057286:Electronic Health Records / Q000706:statistics & numerical data*; D034742:Electronic Mail; D005006:Ethnicity; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D033283:Patient Access to Records; D000072638:Patient Portals / Q000706:statistics & numerical data*; D017010:Reminder Systems
keywords: electronic health records; medical records; patient activation; patient engagement; reminder systems