1. Partnering with Patients for Safety: The OpenNotes Patient Reporting Tool The Problem Aim/Goal The Team The Intervention Results/Progress to Date Safety experts struggle with effective ways to reduce error in ambulatory care. OpenNotes, an innovation that invites patients to review their clinicians’ notes online may be a means for patients to report possible errors in their notes. To conduct a pilot study to measure the effectiveness the OpenNotes Reporting Tool to solicit positive patient feedback and reports of possible errors in notes. Sigall BellGila Kriegel Roanne MejillaJulia Lindenberg Mary BarryLarry Markson Tom DelbancoElena Premack Sandler Beth FrenchKen Sands Macda GerardJan Walker Amy GoldmanGail Wood Heidi JayPat Folcarelli Susan Johnson  We invited 2 of 10 practice teams in HealthCare Associates to participate in this pilot program  A link at the end of the clinician note led to 10 item survey with both quantitative and qualitative questions.  “Potential Safety Concern” was defined as either not understanding the plan of care or reporting a possible inaccuracy in the note Lessons Learned  Great majority of participants reported understanding notes.  Patients/caregivers reported possible inaccuracies in about one-quarter of reports, resulting in a change in the record or care in the majority of cases.  For every error or near miss caught, there may be false alarms, and shielding busy clinicians from an uptick in calls will be critical to sustainability  An online patient reporting tool linked to open notes can help engage patients as safety partners, support providers with positive feedback, and inform organizations of improvement opportunities. Next Steps  Continue current pilot with a goal of 200 respondents  Explore opportunities to expand reporting tool in ambulatory practices For more information, contact: Sigall Bell, MD: sbell1@bidmc.harvard.edu Asked what they liked or learned from notes, patients and caregivers commented: “It’s a great way to double check I didn’t miss anything if I was not feeling well or was too overwhelmed.” “I like knowing what the results of my tests mean. The records shows the numbers, but the notes provides the interpretation” “…especially helpful for older patients who may have hearing and/or some cognitive/memory loss.” “Health care should be a two-way conversation; this forum provides another opportunity for that.” Reports Submitted from August-December 2014  105 reports were submitted from August-- December 2014  95% were from the patients, 5% from informal caregivers 22% Identified “Potential Safety Concerns” including:  Majority of reports led to a change in the record or in care  Extrapolating to 10 teams, these data predict over 1200 reports and almost 300 otherwise unidentified risks annually, reflecting a nearly 50% increase in ambulatory reporting through our hospital’s online event report system. “I appreciate the opportunity to praise my healthcare providers.” “I appreciate the open exchange and the opportunity to correct any possible misunderstandings.” HCA visit Triggers Note Patient Reads Note and at the end of the note is invited to give feedback in safety reporting tool Patient Relations reviews all responses Safety Concern? Yes No Patient Relations reaches out to patient and/or clinician to discuss concern and then loop with patient is closed Aggregate data on survey feedback is captured in database for study