How Do OpenNotes Policies Affect Healthcare Disparities? A Computational Approach

Modified Project Summary/Abstract Section The OpenNotes rule in the United States enables all patients to have easy access to their medical records. The policy affords many benefits to patients such as increased accessibility, improved transparency, and better communication with medical providers. Additionally, OpenNotes may help address health disparities by increasing transparency in provider documentation and medical decision-making. However, there is ongoing discussion regarding the potential impacts of this policy on the quality of clinical documentation. Certain documentation styles may limit the detail or type of information recorded in notes, and patients may encounter challenges in understanding the terminology and format of clinical notes. While the nationwide rollout of OpenNotes may have implications for the quality of documentation and patient perceptions of care, most studies rely on self-reports through survey mechanisms or a limited number of clinical specialties. We will characterize the effects of OpenNotes on clinical documentation through an empirical computational analysis, comparing changes in clinical language before and after the policy implementation. In support of our analysis, we will develop clinical Natural Language Processing (cNLP) tools to analyze medical language and identify the most likely types of documentation changes. Our focus will be on mental health care due to the sensitive nature of these notes. We will use cNLP tools to identify changes and patterns in language use in EHR notes, comparing language before and after OpenNotes went into effect. We will also evaluate the effect of OpenNotes policies on language in patient records for various patient populations, and examine how policy changes may relate to changes in healthcare disparities. Our analysis will draw on clinical notes from patient care settings within the Johns Hopkins Medical System and two specialties: mental health, selected because of the potential high impact of OpenNotes, and primary care, a comparison setting for which we expect different types of changes.