The evidence is building steadily. Sharing notes can help you improve communication with your patients, build stronger, more trusting relationships, and enhance patient safety, without adding to your workload.
Accuracy and safety
You probably read and write thousands of notes every year. The only notes your patients review are their own. Sharing adds a second set of eyes. Patients can report on clinically important discrepancies, particularly those involving medications and inaccurate documentation. Research indicates that 25% of patients who contact their doctor as a result of reading their note report a possible error. And open notes remind patients of important next steps, such as diagnostic and screening tests, referrals, and immunizations. It sends a strong message about transparency and inclusivity that turns passive patients into active safety partners. It builds trust. Moreover, open and honest communication can help decrease litigation, as demonstrated repeatedly in studies addressing medical error disclosure.
“One of the advantages of the note is that if the patient has doubts or questions, she may look back at the note and see. What is the plan, and what did we discuss?”— Arturo Diaz, MD, Rheumatology, Beth Israel Deaconess Medical Center
According to research estimates, poor adherence to medications in the USA may contribute to 125,000 deaths and $100 billion in excess health care costs each year. In a study published in 2012, up to 78% of patients reported that open notes helped them take their medications as prescribed. In interviews and focus groups with patients and families we have gathered considerable evidence supporting these survey findings. More recently, a study by the Geisinger Center for Health Research found that patients offered access to notes were more likely to fill their prescriptions for blood pressure medication.
“Encouraging patients to utilize a web portal to view their doctor’s note is a cost effective and efficient way to influence medication taking behavior.”
— names of study authors
Stronger relationships, better engagement
More than half of the doctors participating in a recent study felt that sharing notes led to improved patient satisfaction and trust. Meanwhile, a majority of patients reported that reviewing their notes made them feel the same or better about their doctor. The findings are striking. Sharing notes with your patients can lead to better communication, more collaborative decision-making and stronger relationships. We are learning that open notes can be powerful tools for enhancing engagement. Moreover, considerable research demonstrates that engaged patients have better outcomes.
of patients in one study said that accessing their notes made them feel more in control of their health care.
Impact on chronic disease
Navigating the health care system can be hard for anybody, but it’s often hardest for the 117 million Americans managing chronic health conditions. Open notes can be particularly helpful for them. In addition to enhancing recall and understanding, patients can review complex data, including multiple changes in medications or treatment plans. Just as importantly, they can share up-to-date, accurate information with family, specialists, and others involved in their care.
“In many cases I’m looking at multiple options and trying to find the best way to manage my health issues. Having open notes and access to all my information has given me much more control of my health care.”— Eileen Hughes, patient
Support for caregivers helping your patients
OpenNotes is not just for your patients. It can assist and support family, friends, and others who are care partners and caregivers. They can review the notes and better manage the health needs of the people in their care, including scheduling visits, reconciling medication lists, and following through on a host of recommendations. In a recent study, care partners reported benefits from note sharing similar to those reported by patients. Additionally, care partner access to notes can serve as a bridge for patients with limited English, low health literacy, and those without computers or access to the internet.
“Family members are among the most vigilant of health system stakeholders.”— Jennifer L. Wolff, PhD, Johns Hopkins Bloomberg School of Public Health
Addressing mental health and illness
Open notes hold promise for helping the therapeutic process, as well as reducing the stigma of mental health and illness. Sharing notes can build trust, making patients feel more understood by social workers, psychiatrists, and others on the health care team. Such connection can enhance patients’ willingness to address mental health issues more actively. Some psychotherapists say that inviting patients to see their issues in writing can catalyze behavior change more effectively than discussion alone. Using notes as an integral component of therapy is attracting considerable interest among mental health professionals and their patients. Formal studies are now under way, and we hypothesize that they’ll show that open notes have a positive impact.
“I believe that making sweeping determinations to block records from patients suffering from behavioral health conditions amounts to treating them like second-class citizens.”
New opportunities for efficiency
You may well worry that sharing notes will add to your workload and time pressures. The evolving literature and experience says otherwise. In one study, fewer than 5% of doctors reported spending more time addressing patient’s questions outside of visits, and most reported not changing the way they wrote notes. Indeed, most of those who adjusted their writing felt they improved their notes. We have not received complaints of having to “dumb down” notes, thereby impairing communication with colleagues. What’s more, patients who read their notes are more likely to be engaged between visits, and may arrive at their next visit better prepared. In the future, allowing patients to contribute to the record, including updating the family and social history, writing a concise, structured interval history, and proposing a visit agenda, could off-load work during a visit and free up time, which could prove mutually beneficial.
“OpenNotes and sharing the notes made me do a better job and made me more efficient. I went home at the end of every day finished with all my notes.”