Safety gaps remain from unclosed loops
Do patients who read visit notes via patient portals have a higher rate of “loop closure” on diagnostic tests and referrals? The quick answer is yes, according to a study led by Sigall Bell, MD—OpenNotes Director of Patient Safety & Discovery, and Associate Professor of Medicine at Harvard Medical School.
“After controlling for sociodemographic and clinical factors, the odds of a loop closure were 20% higher in tests or referrals for patients with a portal account, and 40% higher in tests or referrals for note readers, compared with those not registered for the patient portal,” said Dr. Bell, lead author for the study. The study was published in the Journal of the American Medical Informatics Association (JAMIA).
To do this work, Dr. Bell and colleagues conducted a retrospective cohort study of patients with primary care visits from January 2018 to December 2021—looking at a period of time both before and after the implementation of the 21st Century Cures Act information blocking rule. The investigators reviewed orders for colonoscopies, dermatology referrals, or cardiac stress tests at two academic primary care clinics. They examined the differences between the timely completion of tests or referrals (aka “loop closures”) for patients who used the portal and read at least one open note (Portal + Notes), those with a portal account but who did not read an open note (Portal Account Only), and those who did not register for the portal (No Portal).
Among nearly 13,000 tests or referrals, Bell and colleagues discovered that loop closures were more common among patients who were Portal + Note-readers, compared with their counterparts for all tests or referrals (54.2% No Portal, 57.4% Portal Account Only, 61.6% Portal + Notes). In an adjusted analysis, compared with the No Portal group, the odds of a loop closure were significantly higher for the Portal Account Only and Portal + Notes groups. Beyond portal registration, note-reading was independently associated with loop closure.
Bell SK, Amat MJ, Anderson TS, at al. Do patients who read visit notes on the patient portal have a higher rate of “loop closure” on diagnostic tests and referrals in primary care? A retrospective cohort study, Journal of the American Medical Informatics Association, Volume 31, Issue 3, March 2024, Pages 622–630, https://doi.org/10.1093/jamia/ocad250
For more information about Dr. Bell’s research, visit opennotes.org/ourdiagnosis.
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About OpenNotes
OpenNotes is an international movement spreading, studying, and teaching transparent communication among patients, families, and clinicians. When clinical notes are shared with patients, they are called ‘open notes.’ OpenNotes is motivated by evidence indicating that when health professionals offer patients and families ready access to clinical notes, the quality and safety of care improves. OpenNotes is a not-for-profit research lab based at Beth Israel Deaconess Medical Center, a major Harvard Medical School teaching hospital. opennotes.org
