OpenNotes showing benefits at BIDMC

'It appears that having the patient's ... eyes on clinical notes can help ensure care is safer'
By Mike Miliard
11:17 AM
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Beth Israel Deaconess Medical Center

Five years after being chosen as one of three pilot locations for the OpenNotes project, Beth Israel Deaconess Medical Center is seeing encouraging returns from allowing patients access to their clinical notes.

[See also: OpenNotes: 'This is not a software package, this is a movement']

A study this month in the Joint Commission Journal on Quality and Patient Safety makes the case that such no-holds-barred patient engagement can drive real improvements in quality and safety.

"What we heard from patients and doctors fell into recognizable categories – for example, catching medication errors, better remembering next steps and improved plan adherence, enhanced error reporting, improved coordination of care for informal caregivers of vulnerable patients with many providers and appointments and reduced diagnostic delay," according the report's lead author, Sigall Bell, MD, of the division of general medicine and primary care and assistant professor of medicine at Harvard Medical School.

"In many common safety categories, it appears that having the patient's or an informal caregiver's eyes on clinical notes can help ensure care is safer. Doctors review hundreds or thousands of charts; patients review one: their own," said Bell, in a press statment. "OpenNotes may have a unique role in connecting patients and clinicians in the space between visits."

Starting in 2010, more than 100 primary care doctors at three hospitals invited 20,000 of their patients to read their visit notes through a secure, patient website, as part of the OpenNotes pilot.

Patients reported feeling more in control of their health, being better prepared for their visits and several other benefits. And, despite some initial skepticism, physicians saw little or no impact on their workflows.

The number of patients who are able to read their visit notes has since grown to more than five million, nationwide.

With five years of OpenNotes experience, BIDMC has seen heartening trends with regard to engagement, patient safety and quality of care.

Among other things, patients reported that seeing their doctors' notes helped them remember to take their medications and recall more of what happened during office visits. Some noticed errors in their records that were subsequently corrected. Others were reminded to follow up on clinically significant appointments.

"These are all examples of patients who used the notes to engage in their own health care and to play active roles in making their care better," said Bell. "The message that we are getting from many patients is that they want to participate in their care. And while the responsibility for patient safety still rests primarily with health care organizations, this research shows us what's possible when we make space at the table for patients."

Docs are liking the project, too, according to BIDMC: "I felt like my care was safer, as I knew the patients would be able to update me if I didn't get it right," one physician wrote.

Still, there were some concerns, such as a worry that, knowing their patients would be reading them, clinicians would be more vague in their notes. Other doctors had qualms about about how patients would define mistakes, how they'd report errors – and, ultimately, how that process might impact patient/provider trust.

"We understand that these are real concerns that need to be addressed with education, innovation and further research," said Bell. "But, we think solutions can be reached. Data suggest that transparent communication can enhance trust, and that activated patients have better experiences of care. The benefits of partnering with patients in this way are likely well worth the effort."