Data from: Open notes sounds great, but will a provider’s documentation change?

Background: The effects of shared clinical notes on patients, care
partners, and clinicians (“open notes”) were first studied as a
demonstration project in 2010. Since then, multiple studies have shown
clinicians agree shared progress notes are beneficial to patients, and
patients and care partners report benefits from reading notes. To
determine if implementing open notes at a hematology/oncology practice
changed providers’ documentation style, we assessed the length and
readability of clinicians’ notes before and after open notes
implementation at an academic medical center in Boston, MA. Methods: We
analyzed 143,888 notes from 60 hematology/oncology clinicians before and
after the open notes debut at Beth Israel Deaconess Medical Center, from
January 1, 2012, to September 1, 2016. We measured the providers’ (medical
doctor/nurse practitioner) documentation styles by analyzing character
length, the number of addenda, note entry mode (dictated vs. typed) and
note readability. Measurements used five different readability formulas
and were assessed on notes written before and after the introduction of
open notes on November 25, 2013. Results: After the introduction of open
notes, the mean length of progress notes increased from 6,174 characters
to 6,648 characters (P<0.001), and the mean character length of the
“assessment and plan” (A&P) increased from 1,435 characters to
1,597 characters (P<0.001). The Average Grade Level Readability of
progress notes decreased from 11.50 to 11.33, and overall readability
improved by 0.17 (P=0.01). There were no statistically significant changes
in the length or readability of “Initial Notes” or Letters, inter-doctor
communication, nor in the modality of the recording of any kind of note.
Conclusions: After the implementation of open notes, progress notes and
A&P sections became both longer and easier to read. This suggests
clinician documenters may be responding to the perceived pressures of a
transparent medical records environment.