• Suzanne G Leveille, Patricia Fitzgerald, Kendall Harcourt, Zhiyong Dong, Sigall Bell, Steve O'Neill, Catherine DesRoches, Leonor Fernandez, Sara L Jackson, KleinJared WJWDivision of General Internal Medicine, School of Medicine, University of Washington, Seattle, WA, USA., Rebecca Stametz, Tom Delbanco, and Jan Walker.
• College of Nursing and Health Sciences, University of Massachusetts, Boston, MA, USA.
• J Gen Intern Med. 2020 Dec 1; 35 (12): 3510-3516.

BackgroundPatients actively involved in their care demonstrate better health outcomes. Using secure internet portals, clinicians are increasingly offering patients access to their narrative visit notes (open notes), but we know little about their understanding of notes written by clinicians.ObjectiveWe examined patients' views on the clarity, accuracy, and thoroughness of notes, their suggestions for improvement, and associations between their perceptions and willingness to recommend clinicians to others.DesignWe conducted an online survey of patients in 3 large health systems, June-October 2017. We performed a mixed methods analysis of survey responses regarding a self-selected note.ParticipantsRespondents were 21,664 patients aged 18 years or older who had read at least 1 open note in the previous 12 months.Main MeasuresWe asked to what degree the patient recalled understanding the note, whether it described the visit accurately, whether anything important was missing, for suggestions to improve the note, and whether they would recommend the authoring clinician to others.Key ResultsNearly all patients (96%) reported they understood all or nearly all of the self-selected note, with few differences by clinician type or specialty. Overall, 93% agreed or somewhat agreed the note accurately described the visit, and 6% reported something important missing from the note. The most common suggestions for improvement related to structure and content, jargon, and accuracy. Patients who reported understanding only some or very little of the note, or found inaccuracies or omissions, were much less likely to recommend the clinician to family and friends.ConclusionsPatients overwhelmingly report understanding their visit notes and usually find them accurate, with few disparities according to sociodemographic or health characteristics. They have many suggestions for improving their quality, and if they understand a note poorly or find inaccuracies, they often have less confidence in their clinicians.

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