Opening Up with Open Notes: Writing Notes in the Era of Full Patient Access

Posada, Jacqueline; Potvin, Hannah; Cookson, Carolyn

doi:10.1007/s40596-021-01510-2

Cited by 3 publications

(1 citation statement)

References 12 publications

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“…Health care has become more directly accessible to the patient, in part due to the Health Information Technology for Economic and Clinical Health Act of 2009 [ 1 ], and also, as a result of increasing consumer demands [ 2 ].When first introduced, patient portals provided patients with limited access to their medical records and adoption was low [ 3 ]. In part to meet meaningful use requirements of the Health Information Technology for Economic and Clinical Health Act, web-based electronic health record portal capabilities have expanded to appointment scheduling, displaying lab results or viewing encounter notes written by their physician [ 4 ], allowing bills payments, and facilitating communication with care teams, costs estimates for ambulatory services [ 5 ], and access to family records. Patient access rates to web-based patient portals have increased to 90% in some organizations [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Effects of Behavioral Economics–Based Messaging on Appointment Scheduling Through Patient Portals and Appointment Completion: Observational Study

Liang¹,

Stults²,

Jones³

et al. 2022

JMIR Hum Factors

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Background Behavioral economics–based techniques have been an increasingly utilized method in health care to influence behavior change by modifying language in patient communication (through choice architecture and the framing of words). Patient portals are a key tool for facilitating patient engagement in their health, and interventions deployed via patient portals have been effective in improving utilization of preventive health services. Objective We examined the impacts of behavioral economics–based nudge health maintenance reminders on appointment scheduling through a patient portal and appointment completion for 2 preventive services: Medicare wellness visits and Pap smear. Methods We conducted a retrospective observational study using electronic health record data from an integrated health care system in Northern California. Nudge health maintenance reminders with behavioral economics–based language were implemented for all sites in November 2017 for Medicare wellness visits and for selected sites in February 2018 for Pap smears. We analyzed 125,369 health maintenance reminders for Medicare wellness visits, and 585,358 health maintenance reminders for Pap smear sent between January 2017 and February 2020. The primary outcomes were rate of appointments scheduled through the patient portal and appointment completion rate. We compared the outcomes between those who received the new, behavioral economics–based health maintenance reminders (the nudge group) and those who received the original, standard health maintenance reminders (the control group). We used segmented regression with interrupted time series to assess the immediate and gradual effect of the nudge for Medicare wellness visits, and we used logistic regression to assess the association of nudge health maintenance reminders, adjusting for the propensity to receive a nudge health maintenance reminder, for Pap smear. Results The rates of appointments scheduled through the patient portal were higher for nudge health maintenance reminder recipients than those for control health maintenance reminder recipients (Medicare wellness visits—nudge: 12,537/96,839, 13.0%; control: 2,769/28,530, 9.7%, P<.001; Pap smear—nudge: 8,239/287,149, 2.9%; control: 1,868/120,047, 1.6%; P<.001). Rates of appointment completion were higher for nudge health maintenance reminders for Pap smear (nudge: 67,399/287,149, 23.5% control: 20,393/120,047, 17.0%; P<.001) but were comparable for Medicare wellness visits (nudge: 49,835/96,839, 51.5% control: 14,781/28,530, 51.8%; P=.30). There was a marginally gradual effect of nudge on number of appointments scheduled through the patient portal for the overall Medicare wellness visits sample (at a monthly rate of 0.26%, P=.09), and a significant gradual effect among scheduled appointments (at a monthly rate of 0.46%, P=.04). For Pap smear, nudge health maintenance reminders were positively associated with number of appointments scheduled through the patient portal (overall sample: propensity adjusted odds ratio [OR] 1.62; 95% CI 1.50-1.74; among scheduled appointments: propensity adjusted OR 1.61, 95% CI 1.47-1.76) and with appointment completion (propensity adjusted OR 1.07; 1.04-1.10). Conclusions Nudges, a behavioral economics–based approach to providing health maintenance reminders, imcreased the number of appointments scheduled through the patient portal for Medicare wellness visits and Pap smear. Our study demonstrates that a simple approach—framing and modifying language in an electronic message—can have a significant and long-term impact on patient engagement and access to care.

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Section: Introductionmentioning

confidence: 99%

Effects of Behavioral Economics–Based Messaging on Appointment Scheduling Through Patient Portals and Appointment Completion: Observational Study

Liang¹,

Stults²,

Jones³

et al. 2022

JMIR Hum Factors

View full text Add to dashboard Cite

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Stigma and Change

Brenner

2022

Acad Psychiatry

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Effects of Behavioral Economics–Based Messaging on Appointment Scheduling Through Patient Portals and Appointment Completion: Observational Study (Preprint)

Liang¹,

Stults²,

Jones³

et al. 2021

Preprint

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BACKGROUND Behavioral economics has been an increasingly utilized method in healthcare to “nudge” behavior change through the use of techniques such as choice architecture and framing of words. Patient portals are a key tool for facilitating patient engagement in their health, and deployment of interventions via patient portals have been effective in improving utilization of preventive health services. Our integrated healthcare system was one of the first to employ behavioral economics in health maintenance reminder (HMR) messages sent through the online patient portal to improve patient engagement and preventive service use. OBJECTIVE We examined the impacts of behavioral economics-based nudge HMRs on online scheduling uptake and appointment completion for two preventive services, Medicare wellness visits (MWV) and pap smears. METHODS This was a retrospective observational study using electronic health record data from an integrated healthcare system in Northern California. Nudge HMRs with behavioral economics-based language were implemented in November 2017 to all sites for MWV and selected sites in February 2018 for pap smears. We analyzed 125,369 HMRs for MWV, and 585,358 HMRs for pap smears sent between January 2017 and February 2020. The primary outcomes were online scheduling and appointment completion. The predictor was the receipt of a nudge HMR. We used segmented regression with interrupted time series design to assess the immediate and gradual effect of the nudge for MWV. For Pap smear, we used logistic regression models to assess the association of the nudge HMR on study outcomes, adjusting for the propensity to receive a nudge HMR. RESULTS Rates of online scheduling were higher for nudge HMRs recipients than control HMRs (13.0% nudge vs. 9.7% control for MWV; 1.4% nudge vs. 0.6% control for pap smears; p<0.001 for all comparisons). Rates of appointment completion were higher in nudge HMRs for pap smears (21.4% nudge vs. 15.3% control, p<0.001) but comparable for MWV between the two groups (51.5% nudge vs. 51.8% control, p=0.30). Regression results suggest a marginally gradual effect of nudge on online scheduling for the overall MWV sample (at a monthly rate of 0.26%, p=0.09), and a significant gradual effect among scheduled appointments (at a monthly rate of 0.46%, p=0.04). For pap smears, nudge HMRs were positively associated with online scheduling (propensity adjusted odds ratio [OR] 1.68; 95% confidence interval [CI] 1.50–1.88 overall sample; propensity adjusted OR 1.65 [1.45–1.87] among scheduled appointments) and appointment completion (propensity adjusted OR 1.07 [1.04–1.10]). CONCLUSIONS Nudge for health, a behavioral economics-based approach to providing HMRs, improves patient online scheduling for Medicare wellness visits and pap smears. Our study demonstrates that a simple approach of framing and modifying language in an electronic message can have a significant and long-term impact on patient engagement and access to care. CLINICALTRIAL No

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Opening Up with Open Notes: Writing Notes in the Era of Full Patient Access

Cited by 3 publications

References 12 publications

Effects of Behavioral Economics–Based Messaging on Appointment Scheduling Through Patient Portals and Appointment Completion: Observational Study

Effects of Behavioral Economics–Based Messaging on Appointment Scheduling Through Patient Portals and Appointment Completion: Observational Study

Stigma and Change

Effects of Behavioral Economics–Based Messaging on Appointment Scheduling Through Patient Portals and Appointment Completion: Observational Study (Preprint)

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