Patient access to e-notes may become 'standard of care'

Allowing patients access to physicians' electronic notes is becoming more popular, and is influencing the content of the notes themselves, according to a new op-ed article in the New England Journal of Medicine.   

The article, written by several participants in the OpenNotes experimental program, states that while the initiative has been welcomed by both patients and physicians, it has changed their approach and drafting of the notes.

Patients are now more careful about what they share with physicians and desire more control over the information. The clinicians are wary about how they phrase notes, particularly about sensitive medical conditions.

They also express difference preferences about sharing the notes, with some clinicians wanting to hide some of the note or the ability to communicate with colleagues privately.

And, of course, there's increased concern about protecting the privacy of the notes.

The Cleveland Clinic recently made office notes available through its patient portal, David Levin, M.D., CMIO of the Cleveland Clinic, told FierceHealthIT in a recent interview. Hospital notes are coming soon, he said. 

Levin, who spoke at this week's mHealth Summit about using moblile technologies to improve patient satisfaction added that it has caused a stir among physicians but patients seem to like it. "We have to acknowledge this is new and we're still learning," he said. "But initially it's been overwhelmingly positive."

The op-ed authors predicted that as nearly two million Americans now have access to their electronic notes, open notes will become the standard of care.

"Regardless of the setting, open notes can help improve patient safety by allowing contributions from patients and families who may catch questionable statements or clinically important mistakes in notes or find lapses in follow-up that need to be rectified," the authors wrote.  

Levin has had the same experience at Cleveland Clinic. 

"We're actually finding patients help us fill in gaps in the record and find errors in the record. And I know that makes some people queasy," he told FierceHealthIT. But we think this is a boon for patient safety. The position I take is the error is already there. This is about all of us working together to correct it."

OpenNotes, a one-year experimental program, involved 105 primary care physicians and 13,564 patients at Geisinger, Beth Israel Deaconess Medical Center in Boston, and Harborview Medical Center in Washington. The program alerted patients by email each time their physician posted a note about the patient into the patient's EHR. The patient could then access the note through a patient portal.

Fully 99% of patients in the experiment recommended that this transparency continue, reporting an increased sense of control, greater understanding of their medical issue and improved recall of their plans of care. The physicians found that the note sharing strengthened their relationships with some patients and may have improved patient safety and satisfaction. The concept has since been expanded within not only by the original health systems but also beyond to other hospitals.

To learn more:
- read the op-ed