Sharing notes can improve communication among patients, families, and clinicians, build stronger, more trusting relationships, enhance patient safety, and strengthen adherence to medications.
Accuracy and Safety
Health care practitioners read and write thousands of notes every year. Quality and accuracy matter, and when patients review their notes they add a second set of eyes. Patients may report on clinically important discrepancies, particularly those involving medications and inaccurate documentation. Studies find that close to 10% of patients find errors in their records, and they view a quarter of these as serious. Importantly, 25% of doctors who have been offering open notes for more than a year report that patients have found errors that they, the doctors, felt were serious. And open notes remind patients of important next steps, such as diagnostic and screening tests, referrals, and immunizations.
Moreover, open and honest communication can help decrease litigation, as demonstrated repeatedly in studies addressing medical error disclosure.
Frequency and Types of Patient-Reported Errors in Electronic Health Record Ambulatory Care Notes , JAMA Network Open (2020)
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 2019, a majority of patients reported that open notes improved their understanding of why and how to take their medications, and one out of six patients surveyed reported that open notes led them to adhere to their regimen more closely. In interviews and focus groups with patients and families we have gathered many anecdotes supporting these survey findings. Moreover, 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.
Improved adherence to medications is clearly among the most important clinical benefits transparent communication can confer.
“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.”
Patients Managing Medications and Reading Their Visit Notes: A Survey of OpenNotes Participants , Annals of Internal Medicine (2019)
Sharing Physician Notes Through an Electronic Portal is Associated With Improved Medication Adherence: Quasi-Experimental Study , Journal of Medical Internet Research (2015)
Stronger Relationships, Better Engagement
In a recent study, a majority of patients reported that reviewing their notes made them feel the same or better about their doctor, and more than half of the doctors participating reported that sharing notes led to improved patient satisfaction and trust. Evidence is growing that sharing notes with patients can lead to better communication, more collaborative decision-making and stronger relationships. Perhaps most importantly, open notes can be powerful tools for enhancing patient engagement, and considerable research demonstrates that engaged patients have better outcomes.
77–87% of patients in one study said that accessing their notes made them feel more in control of their health care.
“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?”
Chronic Disease Management
Navigating the health care system can be overwhelming for the 117 million Americans managing chronic health conditions. For these patients, open notes can be particularly helpful. 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.”
Support for Care Partners
Open notes can assist and support family, friends, and others who are care partners and caregivers. Reviewing notes helps them 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.
Care partners are often under enormous stress, and the Covid-19 pandemic has magnified virtually all the contributing factors. Transparent communication can play a large role in diminishing burdens care partners themselves experience.
“Family members are among the most vigilant of health system stakeholders.”
Patients, care partners, and shared access to the patient portal: online practices at an integrated health system , Journal of the American Medical Informatics Association (2016)
Clinician Toolkit: Open notes and care partners
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, psychologists, 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.
The new federal rules prohibiting “information blocking” will accelerate transparent communication for those with mental illness, and our experience so far suggests that this will prove a positive step forward, both for those who are ill and for those who offer care.
“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 worry that sharing notes will add to their workload and time pressures. The evolving literature and experience suggests otherwise. In one study, fewer than five percent of doctors reported spending more time addressing patients’ questions outside of visits, and most reported not changing the way they wrote notes. Overall, those who adjusted their writing felt their notes improved. Only rarely do we receive complaints of having to “dumb down” notes, leading to impaired communication with colleagues.
Moreover, patients who read their notes are more likely to be engaged between visits. They may arrive at their next visit better prepared. In the future, inviting patients to contribute to the record by writing a concise, structured interval history, and proposing a visit agenda, may off-load work during a visit and free up time that proves mutually beneficial. This practice, which we term “OurNotes,” may be particularly useful for telemedicine visits. Read more about OurNotes
“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.”
Covid-19 as Innovation Accelerator: Cogenerating Telemedicine Visit Notes with Patients (PDF), NEJM Catalyst (2020)