Advantages of online note sharing with patients outweigh drawbacks

Physicians' fears about sharing visit notes electronically with their patients seem overblown. While much more research needs to be done about the benefits of note-sharing, patients like the idea, and the evidence so far indicates that the practice does not add to doctors' work.

A recent Harvard study in the Annals of Internal Medicine presented baseline data for a yearlong trial of note sharing by primary care physicians in three locations across the country. The participating organizations included Beth Israel Deaconess Medical Center in Boston, Geisinger Health System in Pennsylvania, and Harborview Medical Center in Seattle.

The researchers conducted surveys of patients and physicians prior to the start of the trial. Two results stood out: First, nearly all of the patients wanted to see their doctors' notes, and second, physicians who chose to participate in the trial were less concerned about potential adverse consequences than doctors who declined to do so. Overall, however, the majority of responding physicians believed that note sharing would confuse patients and increase their own work.

In an accompanying editorial, two physicians at University of Texas M.D. Anderson Cancer Center in Houston pointed out that doctors at the center have been sharing visit notes with patients since 2009. Initially, the clinicians had the same concerns as those surveyed for the Harvard study. But "few have voiced complaints" since the note-sharing project began, the editorial said. Since then, the University of Texas has decided to expand the program to all six of its health campuses, the Houston Chronicle noted.

The newspaper also reported that, after the Harvard trial ended last year, the organizations that participated decided to continue allowing physicians to share their notes online with patients via web portals. While that doesn't mean that skeptical practitioners have changed their minds and adopted note sharing, it does suggest that many doctors have found it beneficial in patient care and that it hasn't increased their workload.

In fact, Tom Delbanco, MD, a co-author of the study and a professor at Harvard Medical School, told InformationWeek Healthcare that he has not found note sharing creates more work for him. "For every patient who bugs me more as a result of this, there's another patient who's bugging me less, because my note answered some of his or her questions," he said.

One unintended consequence of note sharing is that physicians might be less candid in their documentation than they would otherwise be. A substantial minority of the physicians involved in the study said this might be the case. The clinical areas where they'd be most likely to pull their punches, they told the researchers, are cancer, obesity, substance abuse and mental health.

Still, the drawbacks of less complete observations in those areas seem to be outweighed by the advantages of providing patients with information that helps them manage their own health better and ask more intelligent questions when they visit their physicians.

Similarly, it makes sense to allow patients to access their lab results directly, as the Department of Health & Human Services has proposed. Although it would be better if physicians saw the results first and could interpret them for patients, the many instances of clinicians failing to follow up on abnormal results makes it imperative for patients to be able to obtain this information themselves.

Despite the consciousness raising of the past decade, there's still a lot of paternalism in medicine. It's time that doctors let patients participate more fully in their own care. - Ken

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