The 21st century has ushered in a distinct emphasis on patient-centered care in allopathic medicine, as manifested by the increasing implementation of patient-centered medical homes and the frequent use of patient-centeredness in guidelines, health systems, and insurance language (1–5). The overall goal of this movement is to improve communication between physicians and patients, ultimately increasing patients’ engagement in care and improving the shared decision-making process, and thereby increasing their proclivity to follow their physicians’ advice. The costs attributed to nonadherence are staggering, estimated at $290 billion for medication nonadherence alone (6). Efforts to improve this situation are clearly warranted.
Studies
Patients Contributing to Their Doctors’ Notes: Insights From Expert Interviews
Background: In a rapidly expanding practice directed toward improved communication, patient engagement, and patient safety, clinicians are increasingly inviting patients to read office visit notes on secure electronic portals. Reports from doctors and patients participating in a pilot study are strongly positive (1). However, although patient-reported outcomes indicate that reading notes is valuable, it is primarily a passive activity. As a next step, inviting patients and their families to contribute to their notes may further patient engagement and offload work from beleaguered doctors.
Objective: To solicit ideas from experts about the concept of OurNotes, an intervention in which patients and families co-produce medical notes with clinicians.
Will use of patient portals help to educate and communicate with patients with diabetes?
Chronic disease management can require daily attention, and increased levels of patient activation and engagement. We examined whether patients with diabetes perceive a greater benefit to having electronic access to their doctors’ clinic notes compared to patients without diabetes. We hypothesized that easy electronic access to these notes may help patients with self-care by improving education and communication.
Generalist physicians’ challenges in understanding specialists’ clinic notes
Millions of patients now have online access to their full electronic medical record, including the clinic notes from general and specialty physicians.1–4 At our institution, all clinic notes have been accessible to patients via a secure patient portal since October 2014,5 Subsequently, some patients are now asking their generalist physicians to answer questions about subspecialists’ clinic…
Patient access to electronic psychiatric records: A pilot study
This is the first study to implement and assess the impact of patients’ access to psychiatric records in an outpatient setting. Although many questions remain to be studied and a more diverse sample is needed for future research, the potential impact to enhance mental health treatment and the patient-clinician relationship is suggested for selected psychiatric patients. Policy around providing psychiatry patients access to their notes can be informed by reactions of both clinicians and patients.
Error disclosure training and organizational culture
Error disclosure, teamwork, and safety culture all improved over a 3-year period during which disclosure training was provided to key faculty in these six institutions. Self‑reported likelihood to disclose errors also improved. The precise impact of the training on these improvements cannot be determined from this study; nevertheless, we present an approach to measuring error disclosure culture and providing training that may be useful to other institutions.
Opthamology patients’ interest in online access to clinic notes at three US clinics
Patients at three US eye clinics were strongly in favour of online access to ophthalmology notes and were optimistic this access would improve their understanding and self-care. Ophthalmologists should consider offering online access to their notes to enhance doctor-patient communication and improve clinical outcomes. Read the full publication here.
What patients value about reading visit notes: a qualitative inquiry of patient experiences with their health information
Background: Patients are increasingly asking for their health data. Yet, little is known about what motivates patients to engage with the electronic health record (EHR). Furthermore, quality-focused mechanisms for patients to comment about their records are lacking.
Objective: We aimed to learn more about patient experiences with reading and providing feedback on their visit notes.
Methods: We developed a patient feedback tool linked to OpenNotes as part of a pilot quality improvement initiative focused on patient engagement. Patients who had appointments with members of 2 primary care teams piloting the program between August 2014-2015 were eligible to participate. We asked patients what they liked about reading notes and about using a feedback tool and analyzed all patient reports submitted during the pilot period. Two researchers coded the qualitative responses (κ=.74).
Inviting patients and care partners to read doctors’ notes: OpenNotes and shared access to electronic medical records
Care partners were more likely to access and use patient portal functionality and reported improved communication with patients’ providers at follow-up. Our findings suggest that offering patients and care partners access to doctors’ notes is acceptable and improves communication and patients’ confidence in managing their care.
Patients Typing Their Own Visit Agendas Into an Electronic Medical Record: Pilot in a Safety-Net Clinic
Collaborative agenda setting is a communication skill that helps patients identify concerns early in the clinic visit, possibly diminishing the number of “Oh, by the way” items at the end of visits, and increasing patient satisfaction. Agenda setting, however, is often limited by time constraints.
Electronic medical records (EMRs) offer patients access to their medical data, including doctors’ notes, and have the capability to facilitate increased patient involvement in their health care and also contribute to their health data. OpenNotes is a national initiative, not a software program, that invites patients to review their visit notes written by their doctors, nurses, or other clinicians. Existing OpenNotes research shows enthusiasm among both patients and clinicians, but this is the first Open-Notes study of cogeneration of clinic notes.
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