Patients who read doctor notes feel more in control of their health

After viewing the notes, they better understand medical issues and are more likely to take medication correctly, a new study says.

By Christine S. Moyer — Posted Oct. 9, 2012

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Physicians who share clinical notes with patients could help improve or resolve medication noncompliance and patients’ lack of involvement in their health care, according to a new study.

A majority of patients who view the notes on secure Internet portals say they feel more in control of their health care. They also are more likely to take medications as prescribed and have a better understanding of their medical issues, said a study in the Oct. 2 issue of Annals of Internal Medicine.

“I want [doctors] to be enthusiastic about this prospect,” said study co-author Tom Delbanco, MD, an internist at Beth Israel Deaconess Medical Center in Boston, one of three sites where the study was conducted. “I think that once [open notes] become part of standard practice and we learn how to use these well, it will enrich the doctor’s experience and the patient’s experience.”

The other sites were Geisinger Health System in Pennsylvania and Harborview Medical Center in Seattle.

Allowing patients to read notes rarely caused confusion, unnecessary anxiety or longer office visits. Depending on the site surveyed, up to 5% of doctors reported longer visits. Up to 8% spent extra time addressing patients’ questions outside office visits.

Dr. Delbanco said an open note system could reduce physician liability risks because it would build trust and a stronger relationship between doctor and patient.

“I’ve long felt the medical record is the hub of the wheel and [giving patients access to it] provides a wonderful opportunity to bring doctors and patients closer together,” said Dr. Delbanco, a professor of general medicine and primary care at Harvard Medical School in Boston.

The findings come as use of electronic health record systems is rising in the United States. In 2011, 34% of physicians used such systems, up from 17% in 2008, according to the National Center for Health Statistics. From 2008 to 2011, the percentage of primary care physicians using EHRs nearly doubled, from 20% to 39%.

Few patients confused by notes

For the Annals study, researchers surveyed 105 primary care physicians and 13,564 of their patients 18 and older during the yearlong study, which was referred to as the OpenNotes trial. As part of the study, which went from summer 2010 to summer 2011, patients received an email with an electronic link to their clinical notes after their physicians signed them electronically.

Doctors and patients were surveyed about their expectations of the program before it started, and they received a similar questionnaire at the end of the program.

Researchers found that anywhere from 47% to 92% of patients at each site who had clinical notes available for viewing opened at least one of those notes. Between 20% and 42% of those patients shared their notes with family members and other people.

Nearly all patients wanted to continue having access to notes after the study ended. That figure includes people who didn’t receive a clinical note during the study and those who opted not to open their notes.

“In contrast to the fears of many doctors, few patients reported being confused, worried or offended by what they read,” said Jan Walker, RN, co-author of the study. She is a principal associate in medicine in the Division of General Medicine and Primary Care at Beth Israel Deaconess Medical Center and Harvard Medical School.

One key limitation of the study is that the results might not apply to all U.S. practices. But Dr. Delbanco said the findings are significant, because they show how much patients favor viewing clinical notes.

“When [nearly] 99% of the patients, even those who don’t read the notes, say this is how practice should work, it’s very hard for me to ignore that,” he said.

The study calls for more research on the health impact of sharing notes with patients and how doctors should implement such programs.

“While an experiment like this raises concerns for many physicians, the strong message from patients is that it makes them better patients,” said Caroline Lubick Goldzweig, MD, MSHS, who wrote an editorial on OpenNotes in the same issue as the study. She is an internist and associate chief of staff, clinical informatics, at the Veterans Affairs Greater Los Angeles Healthcare system.

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Giving patients access to clinical notes does not mean longer visits

Letting patients read notes from their office visits did not confuse them or lead to longer office visits, a study shows. After one year of posting notes on a secure Internet portal, most primary care physicians said having open notes helped with patient communication and was useful for educating people about their health.

Survey questions for doctors Beth Israel Deaconess Medical Center Geisinger Health System Harborview Medical Center
Visits were significantly longer 3% 5% 0%
More time was spent composing clinical notes 21% 14% 0%
Medical care was delivered more efficiently 20% 32% 11%
Notes can be useful for patient communication and education 82% 91% 87%

“Inviting patients to read their doctors’ notes: A quasi-experimental study and a look ahead,” Annals of Internal Medicine, Oct. 2

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