Can sharing physician notes with patients have a positive effect on care?
That is the basic question behind the OpenNotes movement, which sprung out of a three-city pilot program in Boston, Seattle, and rural Pennsylvania and has since gone on to give more than five million patients access to their medical records. Using a patient portal, OpenNotes providers allow their patients to see the complete clinician note. This transparency aims to help patients become more engaged in their healthcare.
Homer Chin, a physician, former executive with Kaiser Permanente, and affiliate professor in the Department of Medical Informatics and Outcomes Research at the Oregon Health and Science University, says thus far, OpenNotes has been a positive experience for doctors and patients. Chin spoke alongside Amy Fellows, executive director of non-profit organization, We Can Do Better, at the annual Healthcare Information and Management Systems Society (HIMSS) conference, held this year in Las Vegas.
In that initial pilot program, 82 percent of patients opened at least one note; 87 percent who had done so said they felt more in control of their care; and 85 percent reported a better understanding of their health and medical condition. Eighty-five percent of patients said OpenNotes would impact their decision on choosing their next provider.
For physicians, Chin said, initial concerns about longer visits and more time having to answer patient e-mails were unfounded. At the end of the pilot, "Not a single doctor had asked to stop," he noted.
Moreover, the pilot showed there was a benefit to physicians, through improved care metrics such as higher medication adherence. Chin said sharing physician notes with patients likely has a positive effect on patient safety, although he didn't have hard data to back it up. He did, however, share an anecdote about a patient who discovered, through OpenNotes, a note from his physician in his record was intended for someone else. Without OpenNotes creating this kind of dialogue, the patient's note could have led to an incorrect and potentially dangerous diagnosis from the physician..
Chin said that malpractice litigation risk would likely decrease for physicians who use OpenNotes, since they will have a more open dialogue with a patient. He also cited two separate studies which claimed OpenNotes had improved outcomes for blood pressure control and its positive effect on mental health patients.
"OpenNotes has a lot of benefits and few side effects. If this was a medication, the pharmacy companies would be advertising it in the news … and telling you to ask your doctor for this," Chin said.
As OpenNotes has expanded through the introduction of the Northwest OpenNotes Consortium, a large group of provider organizations in the Oregon area who have decided to adopt the initiative, it has maintained doctor-friendly statistics. At Kaiser Permanente Northwest, one of the OpenNotes participant organizations, while traffic to the portal from patients accessing a note increased approximately 400 percent from earlier in the year, the number of e-mails to doctors stayed flat. In other words, Chin said, the initiative didn't take up more physician time.
In terms of making this initiative a success, Chin said physician leadership is critical. "Once you get [physicians] on board with this, they can influence the rest of the organization," he said, yet cautioned, "Physician change management is the hardest part of this. The [technology] vendor piece is necessary, but not sufficient."