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A patient feedback reporting tool for OpenNotes: implications for patient-clinician safety and quality partnerships
  1. Sigall K Bell1,
  2. Macda Gerard1,
  3. Alan Fossa1,
  4. Tom Delbanco1,
  5. Patricia H Folcarelli2,
  6. Kenneth E Sands2,
  7. Barbara Sarnoff Lee3,
  8. Jan Walker1
  1. 1Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  2. 2Department of Health Care Quality, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  3. 3Department of Social Work and Patient/Family Engagement, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
  1. Correspondence to Dr Sigall K Bell, Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave; CO-1309, Boston, MA 02215, USA; sbell1{at}


Background OpenNotes, a national movement inviting patients to read their clinicians' notes online, may enhance safety through patient-reported documentation errors.

Objective To test an OpenNotes patient reporting tool focused on safety concerns.

Methods 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.

Results 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.

Conclusions 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.

  • Patient safety
  • Quality improvement
  • Patient-centred care

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  • Portions of this manuscript were previously presented at the Society of General Internal Medicine national meeting 2015, Toronto, Ontario; and the National Patient Safety Foundation Congress 2016, Scottsdale, Arizona.

  • Funding CRICO/Risk Management Foundation of the Harvard Medical Institutions.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.