Although the idea of empowering patients by granting them access to their own medical record is at least 40 years old, the concept has been slow to catch on, and until recent years, much of the medical record has remained inaccessible without legal action. Today, widespread adoption of the electronic medical record is making a fully-transparent health record much more palatable — for patients and physicians. According to an article published in the New England Journal of Medicine, patients who log in to a password-protected portal to read their physicians’ notes following a doctor’s visit have a better understanding of their health situation and feel more ownership in their health plan.
In 2010, more than 100 primary care physicians affiliated with Beth Israel Deaconess Medical Center in Boston, Geisinger Health System in Danville, Pa. and Harborville Medical Center in Seattle volunteered to allow some of their patients read notes from their clinic visits via a secure online portal. Thus, the OpenNotes initiative, sponsored by the Robert Wood Johnson Foundation was born. Although nearly 20,000 participants represented a minority of the doctors’ patients, findings from the trial were telling.
First, it should be noted that 4 out 5 patients took advantage of their doctor’s offer and actually did log in and read the visit notes made available to them. Those who did use the portal reported that they felt more engaged in their care, and more than two-thirds reported more consistency in taking prescribed medication. After the first year, 99 percent of patients wanted access to their physicians’ notes to continue, and 85 percent said such access would impact their choice of care facility in the future.
The majority of doctors said they did not make adjustments in their tone or approach to delivering sensitive information when recording their notes; however, some did admit to modifying the way they addressed certain conditions including: cancer, mental health, substance abuse and obesity. In general, physicians were surprised at how unfazed patients were by reading unedited notations. Authors of the NEJM article, “The Road Toward Fully Transparent Medical Records,” anticipate that open notes will become a standard of care and healthcare systems eventually will expand the practice to include: inpatient hospital services, recuperative and rehabilitation centers, long-term care facilities, home care and other settings. While researchers agree that such an expansion would be an extremely complex task for acute care hospitals, they are convinced that the benefits to patients would be astounding. Allowing patients and families opportunities to address questionable statements, identify significant clinical mistakes or point out lapses in follow-up would greatly improve patient safety.
Not only have the three original OpenNotes participants now opted to open their notes broadly across their organizations, but the study’s findings have prompted high profile institutions including M.D. Anderson Cancer Center, Mayo Clinic and the Veterans Health Administration to follow suit. To learn more about the impact of healthcare’s move toward open medical notes, watch the video below.
OpenNotes: The Evidence is In
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