In recent publicized efforts to get more information to patients about their own medical history, the OpenNotes effort has resulted in providers adding access to physician's notes in online portals at 3 high profile U.S. healthcare organizations.
A study published in the Annals of Internal Medicine in October 2012, reported that after notes became available to patients in online portals, a significant majority of patients reported that they felt more control over their care and increased adherence to medication regimens, while about a quarter had privacy concerns, and 1-8% were offended or confused. Physicians tend to tell it as it is in their notes, and the honesty of notes was expected to be shocking to patients. But it appears this honesty and transparency is refreshing enough to make patients become more compliant and engaged in their health.
The Annals study reported that across the 3 hospitals, the ability to read notes made many patients more active participants in their health, and the added info made them more likely to use portals. Patients already have the legal right to access to their notes (under HIPAA, but the waivers and fees are inconvenient), but an easier way for patients to obtain and read physician's notes is available via the secure portals connected to their medical records in EHRs. Most physicians have installed EHRs with portals to qualify for meaningful use incentives, and most of the commercially available patient portals have configurable functionality that allows physicians to choose which elements of the medical record are available to patients and when. For example, a physician may choose to delay the availability to potentially distressing test results in the electronic portal in order to allow time to notify the patient personally. Most physicians' EHR portals have the configurable capability to open notes, but most physicians with EHRs choose not to enable this functionality.
Historically, the availability of physician notes has been a bone of contention. Physicians are required to take and keep notes to document care and complexity for billing and reimbursement, as well as legal purposes. Physician's notes are typically more direct than the discussion a provider will have had with the patient during a visit, may reveal care plans and diagnostic information that can be distressing for patients, or include opinions about the patient's habits and lifestyle choices. Many physicians consider the contents of notes to be a form of intellectual property. Yet since the advent of EHR, physician notes have left the confines of the handwritten and/or dictated and transcribed paper chart, and become ubiquitous and available to more providers in the care community. Legal discovery has made physicians more aware of what they put in notes. Copy and paste functionality and data entry shortcuts in EHRs have also changed the content of physician notes. Google and online medical information sources like WebMD and UpToDate's BeyondThe Basics, can help patients to decipher terminology and other potentially-confusing information in records and notes. All of these factors have made physician notes have more consumable by patients. As indicated by the Annals study and the experience of the organizations opening notes to patients, it is clearly empowering to know what the doctor is really thinking, and this information can help them to recognize the importance of recommendations and regimens, and boost compliance for many. With physician shortages and ever-more-brief visits, physicians may not have time to go over everything with patients, and notes can fill in the gaps and answer some questions, even if they do raise others.
Since the publication of the study, announcements about OpenNotes on portals have come from Geisinger Health System, the VA, and Beth Israel Deaconness Medical Center, among others. These announcements represent real progress in finding ways to achieve the patient engagement that will be required to achieve the goals of healthcare reform. Has your organization turned opened notes in your patient portal? How has it gone? Email me at jhanover@idc.com and let me know what your experience has been.
This post appeared at IDC Community Insights.