title: A patient feedback reporting tool for OpenNotes: implications for patient-clinician safety and quality partnerships.
abstract: OpenNotes, a national movement inviting patients to read their clinicians' notes online, may enhance safety through patient-reported documentation errors.
  
  
  
  To test an OpenNotes patient reporting tool focused on safety concerns.
  
  
  
  We invited 6225 patients through a patient portal to provide note feedback in a quality improvement pilot between August 2014 and 2015. A link at the end of the note led to a 9-question survey. Patient Relations personnel vetted responses, shared safety concerns with providers and documented whether changes were made.
  
  
  
  2736/6225(44%) of patients read notes; among these, 1 in 12 patients used the tool, submitting 260 reports. Nearly all (96%) respondents reported understanding the note. Patients and care partners documented potential safety concerns in 23% of reports; 2% did not understand the care plan and 21% reported possible mistakes, including medications, existing health problems, something important missing from the note or current symptoms. Among these, 64% were definite or possible safety concerns on clinician review, and 57% of cases confirmed with patients resulted in a change to the record or care. The feedback tool exceeded the reporting rate of our ambulatory online clinician adverse event reporting system several-fold. After a year, 99% of patients and care partners found the tool valuable, 97% wanted it to continue, 98% reported unchanged or improved relationships with their clinician, and none of the providers in the small pilot reported worsening workflow or relationships with patients.
  
  
  
  Patients and care partners reported potential safety concerns in about one-quarter of reports, often resulting in a change to the record or care. Early data from an OpenNotes patient reporting tool may help engage patients as safety partners without apparent negative consequences for clinician workflow or patient-clinician relationships.
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Sigall K
authors.initials: SK
authors.lastname: Bell
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Macda
authors.initials: M
authors.lastname: Gerard
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Alan
authors.initials: A
authors.lastname: Fossa
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Tom
authors.initials: T
authors.lastname: Delbanco
authors.affiliation: Department of Health Care Quality, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Patricia H
authors.initials: PH
authors.lastname: Folcarelli
authors.affiliation: Department of Health Care Quality, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Sands
authors.affiliation: Department of Social Work and Patient/Family Engagement, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Barbara
authors.initials: B
authors.lastname: Sarnoff Lee
authors.affiliation: Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
authors.forename: Jan
authors.initials: J
authors.lastname: Walker
mesh_terms: D000328:Adult; D003299:Cooperative Behavior; D005260:Female; D000068156:Formative Feedback; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation; D010865:Pilot Projects; D011369:Professional-Patient Relations; D058996:Quality Improvement; D017751:Safety Management / Q000592:standards*; D011795:Surveys and Questionnaires
keywords: Patient safety; Patient-centred care; Quality improvement