Studies have shown that easy sharing of clinician encounter notes with patients potentially increases trust and medication adherence, with minimal drawbacks for medical providers.1-3 Although some clinicians have initial reservations, many of their concerns are allayed with experience. With new legislation and regulations, clinicians can expect that more patients will choose to access their medical notes. Here we discuss the movement toward more transparent sharing of medical notes with patients.
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Explore This IssueJanuary 2020
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Background: Patient Visit Notes
The medical notes that clinicians write after patient encounters form a key part of the medical record, allowing clinicians to track medical progress and share information with colleagues. Traditionally, most clinicians did not consider patients’ potential responses to such notes, as they were not usually read by patients.
Laboratory or imaging results represent objective findings, but medical notes include a clinician’s personal views. David Blumenthal, MD, a former primary care physician and current president of The Commonwealth Fund, a philanthropic organization engaging in research on health policy issues, says, “The written products of physicians are more sensitive than the other data, because they are more subjective, and they involve words. Words are both wonderful in their descriptive power and imprecise sometimes. It’s this background of sensitivity that makes notes being public more anxiety provoking for some clinicians.”
Open Notes Initiative
But some people believe patients deserve better access to their patient notes as a matter of principle. Motivated by a belief in the value of patient-centered medicine, the OpenNotes pilot project began in 2010, funded by the Robert Wood Johnson Foundation. At that time, some electronic patient portals offered patients the ability to view certain parts of the medical record online, such as test results, but clinician notes were rarely visible.1
During the pilot project, patients were able to view the notes through the existing patient portals at the participating sites. The pilot project ran for a year in primary care practices at three sites: Beth Israel Deaconess Medical Center, Boston; Geisinger Health System, Pennsylvania; and Harborview Medical Center, Seattle. More than 100 primary care physicians and 13,564 patients were included in this initial study.1
Catherine M. DesRoches, DrPH, an associate professor of medicine at Harvard and executive director of the OpenNotes project, recalls, “When we did the pilot, this idea that you would show patients the clinical notes was at the fringe of medicine, so the clinicians were really worried.” However, the project was deemed successful, with patients reporting benefits and requesting the process be continued. For clinicians, the program seemed to disrupt their work lives only minimally. After the pilot, when clinicians had the opportunity to turn off OpenNotes, none of them did.1
Since then, other institutions have adopted the policy. Follow-up studies have continued to demonstrate the potential benefits of the practice in better patient understanding, trust and compliance.2-4 As Dr. DesRoches notes, “What most places find is that when they turn on note sharing, despite the many worries of their clinicians, there are very few problems.” Currently, over 38 million patients have a portal account with an organization that shares notes to the portal.2
Arturo Diaz, MD, an instructor of medicine at Harvard Medical School, Boston, and a practicing rheumatologist at Beth Israel Deaconess Medical Center says, “Most patients who access their medical records find the information useful to keep track of their labs and other testing. It helps them to understand the status of their disease, and they use the information wisely in interactions with other physicians.”
Adds Dr. DesRoches, “Patients really want this. It has more benefits in terms of how it can help patients engage than it has drawbacks.”