As the OpenNotes movement spreads, it offers important opportunities to learn from many health care professionals and health systems, as well as millions of patients. We’re collaborating closely with researchers across the country and around the world to understand the effects of fully transparent medical care on communication, engagement, safety, costs, and the overall quality of care.
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Evaluating the impact of patients’ online access to doctors’ visit notes: designing and executing the OpenNotes project
Providers and policymakers are pursuing strategies to increase patient engagement in health care. Increasingly, online sections of medical records are viewable by patients though seldom are clinicians’ visit notes included. We designed a one-year multi-site trial of online patient accessible office visit notes, OpenNotes. We hypothesized that patients and primary care physicians (PCPs) would want it to continue and that OpenNotes would not lead to significant disruptions to doctors’ practices.
These days, commentary about bankers, politicians, or school systems is almost invariably accompanied by a call for “increased transparency.” And it’s not different for us in medicine. Spurred by electronic technologies, black boxes are being torn open right and left, bringing disruptive changes to both doctors and patients. We applaud these changes and argue that attendant benefits will far outweigh risks. And whether you agree or not, it’s probably futile to try to interfere with an unstoppable progression.
Inviting Patients to Read Their Doctors’ Notes: Patients and Doctors Look Ahead: Patient and Physician Surveys
Little is known about what primary care physicians (PCPs) and patients would expect if patients were invited to read their doctors’ office notes.
To explore attitudes toward potential benefits or harms if PCPs offered patients ready access to visit notes.
The PCPs and patients completed surveys before joining a voluntary program that provided electronic links to doctors’ notes.
Primary care practices in 3 U.S. states.
Participating and nonparticipating PCPs and adult patients at primary care practices in Massachusetts, Pennsylvania, and Washington.
Few patients read their doctors’ notes, despite having the legal right to do so. As information technology makes medical records more accessible and society calls for greater transparency, patients’ interest in reading their doctors’ notes may increase. Inviting patients to review these notes could improve understanding of their health, foster productive communication, stimulate shared decision making, and ultimately lead to better outcomes. Yet, easy access to doctors’ notes could have negative consequences, such as confusing or worrying patients and complicating rather than improving patient–doctor communication. To gain evidence about the feasibility, benefits, and harms of providing patients ready access to electronic doctors’ notes, a team of physicians and nurses have embarked on a demonstration and evaluation of a project called OpenNotes. The authors describe the intervention and share what they learned from conversations with doctors and patients during the planning stages. The team anticipates that “open notes” will spread and suggests that over time, if drafted collaboratively and signed by both doctors and patients, they might evolve to become contracts for care.
In 2001, the Institute of Medicine recommended improving patient engagement by providing continuous care, allowing patients to be the source of control and fostering transparency with patients and families. Electronic health records (EHRs) facilitate these objectives via the use of patient portals. Giving outpatients direct access to their health information helps clinicians find errors and improves patient satisfaction, although the implications of this type of access have not been well studied in the inpatient setting. This hospital-based study evaluates the experiences of patients, clinicians (including physicians and advanced practice providers), and nurses with immediate (real-time) release of test results and other EHR information through a patient portal.
Pediatricians have long been at the vanguard of innovation in care delivery, most recently leading efforts in participatory care in multiple areas, such as family-centered rounds.