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    Impact of Patient Access to Online VA Notes on Healthcare Utilization and Clinician Documentation: a Retrospective Cohort Study

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    Authors
    Blok, Amanda C.
    Amante, Daniel J.
    Hogan, Timothy P.
    Sadasivam, Rajani S.
    Shimada, Stephanie L.
    Woods, Susan
    Nazi, Kim M.
    Houston, Thomas K.
    UMass Chan Affiliations
    Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences
    Document Type
    Journal Article
    Publication Date
    2021-01-14
    Keywords
    VA
    Veterans Administration
    online patient portal
    clinical notes
    open notes
    UMCCTS funding
    Health Information Technology
    Health Services Administration
    Health Services Research
    Internal Medicine
    Military and Veterans Studies
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    Abstract
    BACKGROUND: In an effort to foster patient engagement, some healthcare systems provide their patients with open notes, enabling them to access their clinical notes online. In January 2013, the Veterans Health Administration (VA) implemented online access to clinical notes ("VA Notes") through the Blue Button feature of its patient portal. OBJECTIVE: To measure the association of online patient access to clinical notes with changes in healthcare utilization and clinician documentation behaviors. DESIGN: A retrospective cohort study. PATIENTS: Patients accessing My HealtheVet (MHV), the VA's online patient portal, between July 2011 and January 2015. MAIN MEASURES: Use of healthcare services (primary care clinic visits and online electronic secure messaging), and characteristics of physician clinical documentation (readability of notes). KEY RESULTS: Among 882,575 unique portal users, those who accessed clinical notes (16.2%; N = 122,972) were younger, more racially homogenous (white), and less likely to be financially vulnerable. Compared with non-users, Notes users more frequently used the secure messaging feature on the portal (mean of 2.6 messages (SD 7.0) v. 0.87 messages (SD 3.3) in January-July 2013), but their higher use of secure messaging began prior to VA Notes implementation, and thus was not temporally related to the implementation. When comparing clinic visit rates pre- and post-implementation, Notes users had a small but significant increase in rate of 0.36 primary care clinic visits (2012 v. 2013) compared to portal users who did not view their Notes (p = 0.01). At baseline, the mean reading ease of primary care clinical notes was 53.8 (SD 10.1) and did not improve after implementation of VA Notes. CONCLUSIONS: VA Notes users were different than patients with portal access who did not view their notes online, and they had higher rates of healthcare service use prior to and after VA Notes implementation. Opportunities exist to improve clinical note access and readability.
    Source

    Blok AC, Amante DJ, Hogan TP, Sadasivam RS, Shimada SL, Woods S, Nazi KM, Houston TK. Impact of Patient Access to Online VA Notes on Healthcare Utilization and Clinician Documentation: a Retrospective Cohort Study. J Gen Intern Med. 2021 Jan 14. doi: 10.1007/s11606-020-06304-0. Epub ahead of print. PMID: 33443693. Link to article on publisher's site

    DOI
    10.1007/s11606-020-06304-0
    Permanent Link to this Item
    http://hdl.handle.net/20.500.14038/46916
    PubMed ID
    33443693
    Related Resources

    Link to Article in PubMed

    Rights
    © Society of General Internal Medicine (This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply) 2021
    ae974a485f413a2113503eed53cd6c53
    10.1007/s11606-020-06304-0
    Scopus Count
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    Population and Quantitative Health Sciences Publications
    UMass Center for Clinical and Translational Science Supported Publications

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