Improving transparency between physicians and their patients by allowing patients to view their visit notes in their health records can improve patient satisfaction, trust and safety, according to a recently published study.
Researchers at Beth Israel Deaconess Medical Center examined the impact of physicians sharing visit notes with patients on the physician-patient relationship as part of a survey, the results of which were published in BMJ Quality and Safety.
According to the study authors, while patient advocates and safety experts encourage adoption of transparent health records, “sceptics worry that shared notes may offend patients, erode trust or promote defensive medicine.”
“As electronic health records disseminate, such disparate views fuel policy debates about risks and benefits of sharing visit notes with patients through portals,” the study authors wrote.
The researchers surveyed 99 volunteer physicians at three U.S. sites who participated in OpenNotes as well as 4,592 patients who read at least one note and submitted a survey.
The OpenNotes movement allows patients electronic access to their provider’s notes in their medical records. The OpenNotes initiative, which started with 20,000 patients in 2010, now includes more than 5 million patients. Its goal is to expand to 50 million patients within three years.
The researchers found that patients read notes to be better informed and out of curiosity. About one-third of patients read them to check accuracy, according to the survey results.
In total, 7 percent of patients reported contacting their doctor's office about their note. Of these, 29 percent perceived an error, and the majority (85 percent) were satisfied with its resolution. Sharing visit notes did not negatively impact how patients perceive their physicians. In fact, 37 percent of patients who viewed at least one share reported feeling better about their doctor, while 62 percent reported feeling the same.
The survey results also indicated that patients who were older (>63), male, non-white, had fair/poor self-reported health or had less formal education were more likely to report feeling better about their doctor.
The feedback from patients contrasts with what physicians anticipated. Among physicians participating in the survey, 26 percent said they anticipated documentation errors, and 44 percent expected that patients would disagree with notes. After a year in the OpenNotes program, 53 percent of physicians believed patient satisfaction increased, and 51 percent thought patients trusted them more. None of the participating physicians reported ordering more tests or referrals.
“Despite concerns about errors, offending language or defensive practice, transparent notes overall did not harm the patient–doctor relationship. Rather, doctors and patients perceived relational benefits,’ the study authors wrote.
And the study authors also concluded, “Traditionally more vulnerable populations—non-white, those with poorer self-reported health and those with fewer years of formal education—may be particularly likely to feel better about their doctor after reading their notes. Further informing debate about OpenNotes, the findings suggest transparent records may improve patient satisfaction, trust and safety.”