What You Need to Know about OpenNotes
OpenNotes is now available to our patients at DHS! This took effect Tuesday, January 16, 2018, and allows patients to view “key” notes through the online Patient Portal.
Key points about OpenNotes at DHS:
- This applies to patients who have signed up for the MyWellness Patient Portal. If your patients are interested in this online access, have them sign-up! Just Google search “la county dhs patient portal” to get to the MyWellness website.
- Only a selection of notes will be available (and this may expand over time), and this is determined by the Note Type that you select:
- Inpatient: History & Physical, Discharge Summary, Consultation notes
- Emergency Room: ED Provider Note
- Outpatient: Consultation notes
*Primary Care notes coming in the near future
- Other notes are already available:
- Imaging reports
- Patient Education documents
- Notes designated as “sensitive” will not be shared on the Patient Portal. These are generally reserved when you suspect physical abuse, substance abuse, mental health issues (<1% of all notes are “sensitive”).
- Notes are available to patients 72 hours after the note is signed.
- Notes signed before the effective live date will not be available.
Tips & Reminders:
- Patients can still request all notes in-person through Medical Records.
- DO explain to patients what they may expect to see in notes.
- E.g. explain what obesity means to the patient and that it may appear in your note
- DO expect patients to read, download, and share your notes.
- DO use situational wording to focus discussion on the problem at hand.
- DO use plain language for planning, less jargon and abbreviations.
- E.g. instead of “f/up SOB,” write out “follow-up shortness of breath”
- DO use descriptions that are less judgmental or confusion.
- E.g. instead of “poor historian” or “disheveled,” state that the “patient could not recall…” or that the “shirt was untucked, beard unshaven”