OpenNotes makes strides but misgivings linger

New research published in the Journal of the American Medical Association found mostly positive feedback from both doctors and patients, though there are still some clinicians who prefer to keep their notes from patients.  
By Jack McCarthy
09:30 AM

OpenNotes continues to earn acceptance and accolades from clinicians and patients alike — but there are still some doctors concerned about enabling patients to view those notes.

 “Sharing medical notes with patients is a trend more health institutions are adopting as they foster transparency in medical records,” Julie Jacob, wrote in the Journal of the American Medical Association (JAMA) article “Patient Access to Physician Notes Is Gaining Momentum.”

Positive feedback from participants in the program shows that a growing number of health systems across the country are making physician notes easily available to patients, Jacob wrote. She cites a January 2016 study in BMJ Open that found that patients who frequently read their physician’s notes reported they better understood their health condition, took better care of themselves, and had a more effective relationship with their physician. The BMJ study mirrors other reports conducted since OpenNotes was launched in 2010 by clinicians and researchers at Beth Israel Deaconess Medical Center in Boston.

Nonetheless, a few misgivings remain about the initiative, the new study found. 

[Also: Geisinger CEO David Feinberg, MD, calls for 'The Year of the Patient']

One is that some patients might be upset by the information they read. In one case, to address the issue, MD Anderson Cancer Center holds laboratory, radiology, and pathology results for seven days and Mayo Clinic delays patient access to radiology and pathology results for three days so doctors can first speak with patients.

In addition, OpenNotes raises issues of access and fairness for patients who don’t have a computer or have a limited knowledge of English.

Also, doctors may censor themselves because patients can “electronically peer over their shoulder,” the study said.

The study cited Steven Malkin, MD, an internist in Arlington Heights, Ill., who said he is concerned that if his patients routinely read his notes, he would be less candid. Malkin practices with Amita Health Medical Care Group, which is not part of the OpenNotes initiative.

“My notes are for me,” Malkin said. “If I knew a patient was going to read them, I would write them differently.”

Whether or not that is good or bad remains to be seen.

At the Healthcare IT News Pop Health Forum 2016 in Boston last week, OpenNotes co-director Tom Delbanco, MD, said that the movement is changing the way doctors write notes and making them more patient-centered.

Delbanco also said that from what he’s seen, only 4 doctors who tried OpenNotes decided to stop using it.

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