Every case depends on the facts. The patients and families who contact our office do their best to remember all that was said and done during critical moments at the doctor’s office, the emergency department or bedside in the hospital. But, the memory of complex medical information unfolding in a tense or unfamiliar setting is rarely 100% for people who have little or no medical background.
In the past few years, thousands of care providers across the nation have finally started to bring patients and their families closer to a true understanding of their own medical diagnoses and care by granting patients open access to their medical records, online.
A study published in 2012 in the Annals of Internal Medicine crystalized the concept that opening patient access to their medical records can increase patient participation in health care and improve outcomes. Named the Open Notes project, the study demonstrated that patients want to play a more active role in their medical care, and their doctors think that’s a “good idea” too.
More than 100 primary care physicians invited 20,000 patients across three U.S. institutions – Beth Israel Deaconess Medical Center (BIDMC) in Boston, Massachusetts, Geisinger Health System (GHS) in Pennsylvania, and Harborview Medical Center (HMC) in Seattle, Washington, to access the records of visits to their doctors’ via an online portal. Just like a bank that sends customers an E-mail notification when a new statement is available, a clinician’s signature on a visit note triggers an Email to the patient that their electronic record is ready to review online.
The vast majority of patients at BIDMC and GHS accessed at least one note. Surveys showed nearly 99% of patients who responded wanted continued access to visit notes. And, 89% of patients indicated that open access to visit notes would be a somewhat or important factor in choosing a doctor or health plan in the future.
Doctors’ experiences with OpenNotes were even more striking: doctors frequently commented that OpenNotes strengthened relationships with their patients, including increased trust, transparency, communication and shared decision making. Doctors commented that OpenNotes may have improved not only patient satisfaction, but also patient safety and education. Pre-study fears of offending or worrying patients, or additional time burden, were overstated and for the most part never materialized.
Ultimately, most patients and their doctors agreed that patients should have the option to access their doctor’s notes on secure portals. The study left the majority of patients with an increased sense of control and understanding of their medical issues. With a greater understanding of their condition came an improve recall of care plans and better preparation for future doctor visits. According to the authors, perhaps the most important clinical achievement of the study was the vast number of patients who reported they were more likely to take medications as prescribed.
Today, several other institutions across the United States, including the VA and two health systems in Pennsylvania, have joined those institutions which participated in the original OpenNotes study. The OpenNotes website reports that 4.5 million patients now have access to clinician notes via secure online portals. In addition to the opportunity to review their doctors’ notes, some patients now have the opportunity to exchange E-mail with their care providers or comment on edits or additions to their medical record.
Four of the physicians who led the landmark study and whose institutes broadly implemented OpenNotes looked back on their findings, the progress of OpenNotes, and the challenges in an editorial earlier this year in the New England Medical Journal. The authors conclude OpenNotes can help improve patient safety and patient trust by creating an environment where patients and their families are encouraged to contribute to their care. Open access to medical records can help patients or their families catch inaccurate statements, mistakes in notes or lapses in care. Ultimately, the authors conclude that OpenNotes will become the standard of care as medical recordkeeping evolves into a system where patients and their doctors will share in generating medical and family histories and subjective descriptions of illness.
OpenNotes has made great gains toward securing patients ready access to their medical records. By helping to increase trust, understanding, and adherence to care plans and medication regimens, OpenNotes is creating an environment conducive to better medical care and fewer harmful or deadly errors.
Facing physical or emotional challenges, even patients with a good understanding of their medical conditions may find it hard to absorb every diagnosis or every instruction. Health care providers are under high demand and tight schedules. Though they should, doctors don’t always take the time to explain and make sure the patient understands the diagnosis, test results, and treatment plan. Enhanced communication and open access to medical records can give patients and their families a better understanding of the medical care at issue. A better understanding of the patient’s medical care and condition provides a safety net, so that people can be more alert for signs of decline, improvement, or changes in condition that might require immediate attention of a healthcare provider.
It is the patient’s loss of trust for a doctor or other care provider which triggers so many people to an attorney – even when no real injury has occurred. Without transparency between a doctor or hospital and the patient, a bad outcome signifies betrayal. When people feel betrayed, they jump to the conclusion that somebody made a mistake. Open access to medical records helps create an obligation for patients and their families to investigate and understand the facts of specific care. With more health care providers adopting programs like OpenNotes, patients and their families can avoid leaping toward conclusions of medical malpractice, and stay on the path to longer, healthier lives.