# How Do OpenNotes Policies Affect Healthcare Disparities? A Computational Approach

> **NIH NIH R21** · JOHNS HOPKINS UNIVERSITY · 2024 · $237,613

## Abstract

Project Summary/Abstract
The new OpenNotes rule in the United States enables all patients 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
improve health disparities by holding providers more accountable for their documentation
practices and medical decisions. However, concerns have emerged about the negative impacts
of this policy on the quality of clinical documentation. Notes may become less detailed and
patients may not understand the medical terminology, problems that may be more prevalent in
populations that experience health disparities. While the nationwide rollout of OpenNotes may
have enormous implications for the quality of documentation and patient perceptions of care,
little empirical evidence is available to guide policy decisions on how to adjust the policy or
mitigate harm. We will characterize the effects of OpenNotes on clinical documentation through
an empirical computational analysis comparing the change in the clinical language before and
after the policy implementation. In support of our analysis, we will develop clinical Natural
Language Processing (cNLP) based tools to analyze medical language focused on the most
likely types of documentation changes. We are especially focused on how these changes
manifest for populations that experience health disparities. Our focus will be on mental health
care due to the particularly sensitive nature of these notes. Furthermore, health disparities are
particularly pronounced in mental health care, and stigmatizing language in behavioral medicine
is of high concern. Our study will characterize changes in medical record language before and
after implementation of OpenNotes policies. We will utilize cNLP tools that can 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 populations that experience health disparities. We will include an analysis of the
presence of stigmatizing language about the patient and examine how policy changes either
entrenched or improved existing 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 control
setting for which we expect minimal impact.

## Key facts

- **NIH application ID:** 10988715
- **Project number:** 1R21MD019870-01A1
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Ayah Zirikly
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $237,613
- **Award type:** 1
- **Project period:** 2024-09-16 → 2026-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10988715

## Citation

> US National Institutes of Health, RePORTER application 10988715, How Do OpenNotes Policies Affect Healthcare Disparities? A Computational Approach (1R21MD019870-01A1). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10988715. Licensed CC0.

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