Why should health care professionals use OpenNotes? Our research indicates that sharing notes can improve communication between you and your patients, build stronger relationships and mutual trust, and improve safety. We believe the benefits to clinicians and patients will increase health care value.
Accuracy and Safety
You may read and write thousands of notes a year, but your patients review only their own. Sharing notes with your patients enables a second set of eyes to review them and catch mistakes early before harm occurs. Patients may report on clinically important discrepancies, particularly those involving medications and inaccurate documentation. While research indicates that patients are unlikely to contact their doctor as a result of reading their note, a quarter of those who did reported a possible error. OpenNotes also reminds patients of important next steps, such as diagnostic and screening tests, referrals, and immunizations. It sends a strong message about transparency and inclusivity, empowering patients as safety partners. And as demonstrated in studies addressing medical error disclosure, open and honest communication can help decrease litigation. OpenNotes may also help build trust, a cornerstone for stemming liability.
“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, we did we discuss.”— Arturo Diaz, MD, Rheumatology, Beth Israel Deaconess Medical Center
Researchers estimate that poor adherence to medications contributes to 125,000 deaths and $100 billion in excess health care costs each year. In a study published in 2012, up to 78 percent of patients reported that OpenNotes helped them take their medications as prescribed, and in interviews and focus groups with patients and families we hear many stories providing further evidence for these survey findings. A more recent 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. The authors write: “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.”
Stronger Relationships, Better Engagement
A majority of patients in a recent study reported that reviewing their notes made them feel the same or better about their doctor. Moreover, more than half of the doctors participating felt that sharing notes led to improved patient satisfaction and trust. Sharing notes with your patients may lead to better communication, more collaborative decision-making, and stronger relationships. OpenNotes may serve as a powerful tool for enhancing engagement, and 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 anyone, but it’s often hardest for the 117 million Americans managing chronic health conditions. For these patients, OpenNotes can be particularly helpful. In addition to enhancing recall and understanding, patients can review complex data, including multiple changes in medications or treatment plans. And 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 OpenNotes 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 can assist and support family, friends, and others who are care partners to your patients. 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 noted by the patients themselves. 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
Notes Addressing Mental Health and Illness
Stigma attached to mental health and illness persists, but OpenNotes holds promise for helping both the therapeutic process and reducing stigma. Reading notes can build and establish trust and help patients feel more understood by their social workers, psychiatrists, and others on the health care team. Such connection can enhance patients’ willingness to address mental health issues more actively, and 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, and formal studies are now under way.
“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
Clinicians often worry that sharing note will add to workload and time pressures. But that’s not what the evolving literature shows. In one study, fewer than 5 percent 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 did adjust their writing felt it made them better. We have not received complaints of having to “dumb down” notes, thereby impairing communication with colleagues. In addition, 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 from the clinician and free up time for mutual benefit.
“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.”