ArticleApplied clinical informatics2022
Lessons Learned from OpenNotes Learning Mode and Subsequent Implementation across a Pediatric Health System.
Article in Applied clinical informatics, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
12 citing papers in PubMed.
- Effect of Notes' Access and Complexity on OpenNotes' Utility.Applied clinical informatics · 2022Trial
- Advice for Improving the Experience of Web-Based Patient Portals: Qualitative Interviews With Caregiver-Adolescent Dyads.JMIR pediatrics and parenting · 2025Article
- Case Report: A health system's experience using clinical decision support to promote note sharing after the 21st Century Cures Act.JAMIA open · 2025Article
- Guiding Principles for Adolescent Web-Based Portal Access Policies: Interviews With Informatics Administrators.JMIR pediatrics and parenting · 2024Article
- Shifting Mindsets: The Impact of a Patient Portal on Functioning and Recovery in a Mental Health Setting.Canadian journal of psychiatry. Revue canadienne de psychiatrie · 2024Article
- The State-of-the-Art of Patient Portals: Adapting to External Factors, Addressing Barriers, and Innovating.Applied clinical informatics · 2023Review
- A Natural Language Processing Model to Identify Confidential Content in Adolescent Clinical Notes.Applied clinical informatics · 2023Article
- The Prevalence of Confidential Content in Adolescent Progress Notes Prior to the 21st Century Cures Act Information Blocking Mandate.Applied clinical informatics · 2023Article
- Creating a Guardrail System to Ensure Appropriate Activation of Adolescent Portal Accounts.Applied clinical informatics · 2023Article
- A Patient-Centered Approach to Writing Ambulatory Visit Notes in the Cures Act Era.Applied clinical informatics · 2023Article
- Article
- Views, Use, and Experiences of Web-Based Access to Pediatric Electronic Health Records for Children, Adolescents, and Parents: Scoping Review.Journal of medical Internet research · 2022Article
Corrections and comments
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Authors and funding
19 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe 21st Century Cures Act has accelerated adoption of OpenNotes, providing new opportunities for patient and family engagement in their care. However, these regulations present new challenges, particularly for pediatric health systems aiming to improve information sharing while minimizing risks associated with adolescent confidentiality and safety.
objectiveDescribe lessons learned preparing for OpenNotes across a pediatric health system during a 4-month trial period (referred to as "Learning Mode") in which clinical notes were not shared by default but decision support was present describing the upcoming change and physicians could request feedback on complex cases from a multidisciplinary team.
methodsDuring Learning Mode (December 3, 2020-March 9, 2021), implementation included (1) educational text at the top of commonly used note types indicating that notes would soon be shared and providing guidance, (2) a new confidential note type, and (3) a mechanism for physicians to elicit feedback from a multidisciplinary OpenNotes working group for complex cases with questions related to OpenNotes. The working group reviewed lessons learned from this period, as well as implementation of OpenNotes from March 10, 2021 to June 30, 2021.
resultsDuring Learning Mode, 779 confidential notes were written across the system. The working group provided feedback on 14 complex cases and also reviewed 7 randomly selected confidential notes. The proportion of physician notes shared with patients increased from 1.3% to 88.4% after default sharing of notes to the patient portal. Key lessons learned included (1) sensitive information was often present in autopopulated elements, differential diagnoses, and supervising physician note attestations; and (2) incorrect reasons were often selected by clinicians for withholding notes but this accuracy improved with new designs.
conclusionWhile OpenNotes provides an unprecedented opportunity to engage pediatric patients and their families, targeted education and electronic health record designs are needed to mitigate potential harms of inappropriate disclosures.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.