Introduction
Secure patient portals have improved patient access to information, including provider notes [1,2]. There is emerging evidence that electronic note sharing improves communication, increases patient and family engagement, and can improve the overall quality of care [[3], [4], [5], [6], [7], [8], [9]]. In a landmark multisite study involving 100 primary care physicians (PCPs), most patients accessing notes via an electronic portal felt more in control of their care, reported increased medication adherence, and wanted note sharing to continue [10]. Results from the same study found that 100 % of PCPs surveyed chose to continue sharing notes with patients at the end of the study. Given these positive results, the OpenNotes® initiative has led to electronic note access for over 40 million U.S. patients through secure portals [11].
Despite the positive response to electronic note sharing, some literature suggests providers have concerns about how electronic note sharing affects their workflow [10,[12], [13], [14], [15]]. Although 99 PCPs across three health care centers in the landmark study appeared to be satisfied with electronic note sharing, 34–46 % thought they would spend more time writing, editing and dictating notes and up to 21 % felt they spent more time on their notes after one year of note sharing [10]. In another study evaluating provider perspectives, residents and faculty physicians voiced concerns in a focus group setting regarding increasing time pressure and the potential workflow impact of electronic note sharing [13]. Faculty physicians also expressed stress about the extra time it would take to review residents’ notes to due to concerns over clinical errors or judgmental language [13].
Given the perception that note authoring time could increase, it is important to measure whether it truly does. Although there is published literature detailing the amount of time providers spend documenting in the electronic health record (EHR) [16], this has not been studied in the specific context of an electronic note sharing implementation. The objective of this study was to 1) survey both specialty and primary care providers about their perceptions related to note sharing at a large academic health center and 2) measure provider note authoring time and change in method of note text creation (assessed by character-level EHR data provenance reported as copied, manual, template and voice recognition text sources) during the three-month period immediately before and after each phase of a two-phase electronic note sharing implementation