Open Notes: Doctors and Patients Signing On

Abstract

Few patients read their doctors' notes, despite having the legal right to do so. As information technology makes medical records more accessible and society calls for greater transparency, patients' interest in reading their doctors' notes may increase. Inviting patients to review these notes could improve understanding of their health, foster productive communication, stimulate shared decision making, and ultimately lead to better outcomes. Yet, easy access to doctors' notes could have negative consequences, such as confusing or worrying patients and complicating rather than improving patient-doctor communication. To gain evidence about the feasibility, benefits, and harms of providing patients ready access to electronic doctors' notes, a team of physicians and nurses have embarked on a demonstration and evaluation of a project called OpenNotes. The authors describe the intervention and share what they learned from conversations with doctors and patients during the planning stages. The team anticipates that "open notes" will spread and suggests that over time, if drafted collaboratively and signed by both doctors and patients, they might evolve to become contracts for care.

Interval Examination: Moving Toward Open Notes

“…[17][18][19][20] In brief, we learned that patients were enthusiastic about the experience and reported potentially important clinical benefits, such as improved recall and understanding of their care plan, improved adherence to their medications, and feeling more in control of their care. We found that doctors were surprised by how few patients appeared troubled by what they read and how little effect the intervention had on the PCPs' work lives.…”

“…How will what clinicians write change, and can one record serve multiple audiences? 17 Can sharing notes reduce morbidity among family caregivers, particularly when their parents or partners near the end of life? How might open notes evolve for patients in a rehabilitation facility, in long-term care, and perhaps most importantly, for those ill at home?…”

When and How Should Clinicians Share Details from a Health Record with Patients with Mental Illness?

“…In 2010, OpenNotes, a pilot study of shared primary care notes, was rolled out across multiple institutions in the United States [4]. Over 100 primary care physicians and about 25,000 patients were enrolled in an observational study in which patients had real-time access to their record through a secure internet portal.…”

Systematic Inquiry for Design of Health Care Information Systems: An Example of Elicitation of the Patient Stakeholder Perspective

“…However, research can also integrate the patient point of view with that of the clinician as it is executed in current health information systems. DelBanco et al [4,5] opened physician notes in an existing EHR as part of the Open Notes project to thousands of patients. Patients reported feeling more in control of their care and sharing the content of notes with others, with no significant increase to physician workload among the physicians volunteering for project.…”