Sharing Visit Notes: Getting Patients and Physicians on the Same Page

 


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Inviting patients to review your visit notes is a promising change in practice. Here's how to get started.

Fam Pract Manag. 2016 Nov-Dec;23(6):10-13.

Author disclosures: no relevant financial affiliations disclosed.

Health care benefits from productive patient engagement, and patient engagement benefits from fully transparent health care. However, patients have long lacked ready access to their health information. Twenty years ago, HIPAA granted virtually all patients the right to review their medical records, but logistical barriers keep most patients from regularly doing so.12

With the widespread adoption of electronic health records (EHRs) and the advent of secure patient portals, patients are now increasingly able to exchange emails with their physicians and review laboratory and radiographic results and medication lists online. But visit notes, which tell the patient's story and weave together disparate issues, have remained largely hidden from patients.

OpenNotes is a national initiative whereby physicians invite patients to review their visit notes. It is not a product or service for sale; it is a movement to allow patients greater access to their health information. In what follows, we outline early experiences, explain how to implement shared notes, point out challenges and unanswered questions, and attempt to demonstrate that this practice holds considerable potential for improving the value and safety of care.

Early experiences

The initial OpenNotes demonstration and evaluation effort in 2010 involved 20,000 patients and more than 100 primary care physicians at three diverse institutions: Beth Israel Deaconess Medical Center in Boston, Geisinger Health System in rural Pennsylvania, and Harborview Medical Center in inner-city Seattle. The findings after a year of intervention were striking. (See “What the research shows.”) Eight of 10 patients chose to read at least one of their visit notes, and three of four reported clinically important benefits, including recalling visit details more completely, understanding their medical conditions better, taking better care of themselves, and feeling more in control of their care.3 Few patients were confused, frightened, or offended after reading their notes, and many shared their notes with family members and caregivers. Whether or not they chose to read their notes, 99 percent of patients wanted the practice to continue after the year-long study, and almost 90 percent reported that the availability of shared notes would affect their future choice of a practice or clinician.3

Clinicians reported that patients who received shared notes seemed to feel more in control of their care, coming to their visits better prepared and asking well-informed questions. Moreover, shared notes enhanced trust and the doctor-patient relationship. More than one third of patients who read at least one note during the OpenNotes trial reported feeling better about their doctor, and shared visit notes had overall positive effects on physician perceptions

About the Authors

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Hannah Chimowitz is a research assistant for the OpenNotes initiative based at Beth Israel Deaconess Medical Center, an academic medical center affiliated with Harvard Medical School in Boston....

Dr. Fernandez is an assistant professor at Harvard Medical School and a researcher for OpenNotes.

Author disclosures: no relevant financial affiliations disclosed.

The authors wish to thank Jan Walker, RN, MBA, and Tom Delbanco, MD, for their comments and suggestions and gratefully acknowledge the Robert Wood Johnson Foundation, Betty Moore Foundation, Peterson Center on Healthcare, and Cambia Health Foundation for their support of the OpenNotes initiative.

 

References

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1. Fioriglio G, Szolovits P. Copy fees and patients' rights to obtain a copy of their medical records: from law to reality. AMIA Annu Symp Proc. 2005:251–255....

2. Shute N. Patients want to read doctors' notes but many doctors balk. NPR. Dec. 21, 2011. http://n.pr/2dFaRMS. Accessed Oct. 3, 2016.

3. Delbanco T, Walker J, Bell SK, et al. Inviting patients to read their doctors' notes: a quasi-experimental study and a look ahead [published correction appears in Ann Intern Med. 2015;162(7):532]. Ann Intern Med. 2012;157(7):461–470.

4. Bell SK, Mejilla R, Anselmo M, et al. When doctors share visit notes with patients: a study of patient and doctor perceptions of documentation errors, safety opportunities and the patient-doctor relationship. BMJ Qual Saf. May 18, 2016.

5. Wright E, Darer J, Tang X, et al. Sharing physician notes through an electronic portal is associated with improved medication adherence: quasi-experimental study. Med Internet Res. 2015;17(10):e226.

6. Tieu L, Sarkar U, Schillinger D, et al. Barriers and facilitators to online portal use among patients and caregivers in a safety net health care system: a qualitative study. J Med Internet Res. 2015;17(12):e275.

7. Klein JW, Jackson SL, Bell SK, et al. Your patient is now reading your note: opportunities, problems, and prospects. Am J Medicine. 2016;129(10):1018–1021.

8. Mafi J, Mejilla R, Feldman H, et al. Patients learning to read their doctors' notes: the importance of reminders. J Am Med Inform Assoc. 2016;23(5):951–955.

9. Walker J, Leveille SG, Ngo L, et al. Inviting patients to read their doctors' notes: patients and doctors look ahead: patient and physician surveys. Ann Intern Med. 2011;155(12):811–819.


 

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