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Should Patients Read Doctors’ Notes?

April 26, 2012
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‘OpenNotes’ provides a tool for patients and clinicians to collaborate. What are the cultural implications?

About a year ago, researchers at Beth Israel Deaconess Medical Center and Harvard Medical School launched an intriguing research project to study what would happen if patients had regular access to their primary care physicians’ notes about their visits. On April 25, the investigators discussed some of their findings during a National eHealth Collaborative webinar.

The OpenNotes project involves three diverse healthcare settings: Beth Israel Deaconess Medical Center in Boston, the Geisinger Health System in rural Pennsylvania, and Harborview Medical Center, a county hospital and safety net provider in Seattle. More than 100 primary care physicians and 20,000 patients participated in a yearlong trial starting in summer 2010. Patients were invited to read the notes written by their PCPs following office visits, e-mail correspondence and phone calls. They are able to view these notes via the portals where other portions of their medical records are posted.

Jan Walker, R.N., M.B.A., co-principal investigator, said the study sought to find out if OpenNotes would prove to be an additional burden to physicians; if it would make them spend more time worrying about and editing notes; or if it would lead them to change the content of what they write/dictate in their notes.

She reminded webinar participants that before the project was launched, surveys found considerable trepidation about it. Physicians who chose not to participate overwhelmingly believed it would be more confusing than helpful. Even among physicians who thought it was a good idea and chose to participate, 50 percent said they thought patients would worry more. They also worried it would change the way they write their notes, especially involving cancer, mental health, substance abuse, and obesity. On the other hand, patients surveyed beforehand were wildly optimistic about the value of the access to physician notes.

Walker said the survey data after 12 months of the study are currently under review and should be published in the next few months. But she did say that even though physicians were allowed to drop out of the study if they wanted to, not a single one did. The commitment of the three healthcare organizations ended after 12 months, but all three chose to leave OpenNotes on and are considering whether to expand its use, she said.

Tom Delbanco, M.D., the principal investigator, reminded listeners that the project is in a “very early stage of what may lead to a big change in the way we do business. I think this is a voyage of inquiry, and we are at the Model T stage, and we have by no means reached a conclusion about this.”

I would be interested to hear what the Healthcare Informatics community thinks of this effort in the context of patient engagement aspect of meaningful use. Could this type of transparency and collaboration help reduce errors and improve patient safety and involve patients more actively in their care? Or is it putting too great a burden on physicians to change how they work and interact with patients?