New York City Health and Hospitals Corporation

Clinical visit notes are an important resource for helping patients and families remember and act on information discussed during a visit, including treatment plans, medication, and care coordination.

Shared visit notes, often referred to as open notes, are an important way to help consumers become active participants in their own care. The 21st Century Cures Act, which went into effect last year, includes a federal mandate that requires all health care providers that maintain electronic medical records to make clinical notes available to patients electronically and at no charge. However, the level of compliance and, most importantly, the proactive use of open notes to improve care varies. For some hospitals, note-sharing is embedded into their practice, and they are ready to expand the types of notes and information they share and to test out innovative ways to meaningfully engage patients. For others, note-sharing is new territory, and they can benefit from adapting proven tools to their own settings and learning best practices from more experienced hospitals. In 2021, NYHealth issued a Request for Proposals (RFP), “From Good to Great: Improving Access to and Use of Patient Visit Notes,” to support hospital facilities in New York State in sharing open notes in compliance with new federal rules and in going beyond compliance to use open notes to more meaningfully engage patients. In 2022, NYHealth awarded New York City Health and Hospitals Corporation (H+H) a grant to participate in this initiative.

Under this grant, 11 hospital facilities within the H+H system continued to implement and improve the use of shared notes, promoting greater information transparency and engaging patients in their care. H+H is the largest public health care system in the nation, serving more than 1 million New Yorkers annually. The City’s safety-net system comprises more than 70 facilities, including 11 acute care hospitals, across the 5 boroughs. With this grant, H+H focused on making notes easier for patients to understand and act on. It also supported patient education through portal enhancements and improved patient-provider communications. H+H participated in a 12-month learning collaborative led by OpenNotes staff to explore strategies and tools for note-sharing, including understanding the new federal mandate; sustaining clinician engagement; adopting effective communication strategies to introduce open notes to both providers and patients; and sharing notes in the context of adolescent, pediatric, inpatient, and behavioral health settings, among other areas.

Participating H+H sites were: Bellevue Hospital, Woodhull Hospital, Coney Island Hospital, Kings County Hospital, Jacobi Hospital, North Central Bronx Hospital, Harlem Hospital, Lincoln Hospital, Queens Hospital, Elmhurst Hospital, and Metropolitan Hospital.

See a full list of grantees participating in this initiative.