Sharing the Doctor’s Note: Win for Patients and Physicians

Quick: when was your last tetanus shot? What was the date of your last surgery? What medications and dosage are you taking? Does cancer run in the family?

It can be hard to accurately remember your entire medical history, but thankfully our medical records, including doctor’s office-visit notes, provide invaluable insight to our health.

The records and notes have always been available in paper form, but were inconvenient to access—until now. Experts say technology has improved doctor and patient dialogue, increased consumer awareness and enticed patients to take a more active role in their health.

OpenNotes , a quasi-experimental year-long study, allowed primary care physicians (PCPs) and patients to examine what happens when patients are invited to read their doctors’ office notes through secure electronic links.

The study, published this month in the Annals of Internal Medicine, details the perceptions of behaviors and consequences of the more than 100 PCPs and approximately 14,000 patients who participated at Beth Israel Deaconess Medical Center (BIDMC), Geisinger Health System and Harborview Medical Center, an entity of University of Washington Medicine (UW Medicine).

“I was wowed by all the information,” says Candice Wolk, a BIDMC patient, “and dumbfounded—almost angered—that I didn’t have this information before.”

The information in the visit notes takes medical records beyond the numbers. “A blood pressure reading of 140/90 is a number in isolation. The note explaining your mother just died tells more of the story,” explains study co-author Jan Walker, a nurse and health services researcher at BIDMC and Harvard Medical School.

Co-author Tom Delanco, a BIDMC physician and professor at Harvard, claims the results have already changed the medical world, saying:

• 90% of patients read their notes
• More than 80% said they had better control of their health
• 20% of patients shared notes with other people
• Approximately two-thirds of participants report increased medication adherence
• 99% say they want the open notes practice to continue
• 85% say their physicians’ use of the practice would be an important determinant in choosing a physician

Over the next year, BIDMC will incrementally roll out OpenNotes as a standard of care among all PCPs, practices and specialties, according to Dr. Kevin Tabb, BIDMC’s president and CEO.

Geisinger and UW will also institute the practice based on the study’s evidence sharing notes online is good for patients. "One of the great challenges in medicine has been to effectively engage patients in their health care. The OpenNotes initiative provides compelling evidence that providing patients access to their doctors' notes can be a powerful tool in accomplishing that goal," says Dr. Jonathan Darer chief innovation officer.

Saving Time and Money

Having real time access to records helps patients save money and time. For example, when a specialist requested blood work that had a two-week wait time for Wolk, she pointed out that she recently had blood work done, and it turned out the PCP’s note contained all the necessary information.

Delbanco points to a patient who reviewed her notes and emailed her doctor to say that she had followed the appropriate plan of care, was feeling well and thought she could skip her immediately upcoming visit. The doctor agreed.

“Multiply that by x-million visits nationwide,” says Delbanco. “It computes to serious cost savings.”

Trust and sharing

Experts claim sharing notes builds trust. Patients often think they are not getting the full story in a 30-minute visit or worry their physician is hiding something. OpenNotes provides full transparency,says Walker.

Equally important, access to the record allows patients to correct errors and potentially help the system reduce medical malpractice litigation, says Michael Meltsner, a law professor at Northeastern University.

OpenNotes also facilitates sharing medical information with immediate family, which is helpful to those facing complicated medical conditions, says Meltsner, recalling his pre-OpenNotes temporary amnesia when receiving a potentially troubling diagnosis.

In much the same way, Wolk describes herself as absent-minded during her pregnancy. She didn’t remember her PCP had found something suspicious and recommended a dermatological follow up. “I had no recollection, but something was nagging at me.” She found the recommendation in her notes, made an appointment and had the appropriate procedure following her twins’ birth.

Wolk says her note access has made her a better patient. A self-described non-complainer, she would tell her doctor she was fine when there may have been several small, nondescript things she would want to discuss—things not big enough for a physician to necessarily question.  Her notes proved she and her physician often missed issues. “Now I mention everything.”

Wolk says the note did include clinical terminology—a point about which OpenNotes skeptics worry. But, she claims, the key takeaway was the callout to see a specialist.

Tabb acknowledges other concerns. Computer entry of medical information is not always as fast as scribbling a written note. But physicians will be able to find information in the system like never before, he says, adding that the younger generation of physicians won’t consider working without a tool like this.

Patients, too, will change standards. Says Meltsner: "I would be very reluctant to choose a doctor who rejected sharing notes.”