Background: Providing patients access to their encounter notes has been found to have many benefits in health management. This evidence has led to a rapidly expanding national movement, OpenNotes, which encourages clinicians to provide patients access to their medical notes.
A major barrier to the utility of open medical notes is the dense medical terminology found in patient notes. The simplification of patient notes to plain language, using computer software, may be an effective solution to this challenge.

Methods: 30 potential study participants were selected from hospitalized patients from UCHealth Anschutz Hospital in July 2018. Proprietary AI software was used to simplify a standardized patient note to a Flesch-Kincaid fifth-grade level reading language. Participants were split into two equal sized groups and each completed a seven-item questionnaire to assess their comprehension of either the simplified or unsimplifeid version of the note. Participants reported their gender, age bracket, ethnicity, highest level of education completed, and completed a two item literacy screener (TILS). Participants participated in a guided interview to understand their perception of the notes.

Linear regression of the demographic variables was performed to assess their impact on number of comprehension questions answered correctly (max score of seven): age group, gender, ethnicity, highest level of education, and health literacy. An independent samples T test of the differences in mean number of questions answered correctly between the groups was performed.

Results: 20 patients agreed to participate in the study. Three broad themes of perceived usefulness of plain language open medical notes emerged in guided interviews: (1) an improved relationship with the provider, (2) increase in the usability of open medical notes, and (3) a feeling that such notes would empower them in daily life.

Linear regression revealed health literacy to be the only demographic factor which demonstrated a significant impact on scores.
Independent samples T test was unable to reject the null hypothesis of no difference in mean comprehension scores between the simplified-note and unsimplified-note groups (p=0.32).

Conclusions: Patients desire access to their medical notes in an accessible format. Guided interviews on simplified medical notes revealed that patients generally perceived plain language medical notes to be desirable and useful.

Statistical analysis was limited by the small sample size (n = 20) and number of question items (seven). Additionally, guided interviews revealed that the simplification algorithms can be improved to enhance the usefulness of the note.

Insight from this study should be used to optimize the delivery and generation of simplified notes. Comprehension should be reassessed with more extensive surveys and a larger sample size. Plain language medical notes may greatly benefit patients and providers and help reduce the burden of many modern healthcare challenges.

IMAGE 1: Broad themes on patient perception of simplified notes and selected quotes from guided interviews