OpenNotes: Transparency Leads to Consumerism

Having worked in healthcare for over 25 years, I am not only very aware of healthcare developments but am most supportive when they improve patient care and awareness. I have a strong belief that our technology in the healthcare and information technology fields should serve the patient as well as the healthcare providers.  One development called OpenNotes, which has encouraging outcomes for both patients and providers, caught my eye in 2012.

So exactly what is OpenNotes? The project is defined on the project’s Web page  as “an initiative that invites patients to review their visit notes written by their doctors, nurses, or other clinicians.” It is not a software program as many would perceive it to be.   Many healthcare software systems now provide a patient portal of some sort, and Meaningful Use objectives and criteria support this source for patients as a “must do.”  So, we can see that technology supports and is capable of supporting the OpenNotes project; however, the greater question is: will the provider actually implement it?

It is now a practice that I am fully supportive of and I can speak to from both an industry and patient perspective.  What makes it even more intriguing, based on the results that the program produced, is that 99% of patients say they want to see their doctor visit notes and  four of five patients say having this access may affect their choice of a medical provider.

Robert Woods Foundation Infographic for OpenNotes

Source: Robert Woods Foundation

 A recent article by Jennifer Thew, posted in HL7 Standards, cleverly and humorously gave a nod to a particular Seinfeld episode where Elaine’s character has a note on her clinical record of “being difficult,” and she engages with Kramer’s character to steal her chart for the purpose of removing the negative comments. The article explains the impression patients and clinicians had of OpenNotes and then what they came to discover by using OpenNotes. he responses to the pre-study survey indicated that the patients were expecting to find out more information on their conditions and medications enabling them to take greater control of their health/disease states; whereas the physicians were more cautious, and they held a variety of opinions on the effectiveness, workflow impact, and how it would affect their patients.

 As mentioned by Thew, we can get a better picture of what the patients came out of from this project:

Percentage of Patients that Opened At Least One Note:

  • Beth Israel Deaconness Medical Center: 84%
  • Geisinger Health System: 82%
  • Harborview Medical Center: 47%

Pie Chart I

Percentage of Patients Who:

  • Reported Having a Better Understanding of Their Health and Medical Conditions: 77 – 85%
  • Felt More In Control of Their Care: 77 – 87%
  • Said They Took Better Care of Themselves: 70 – 72%
  • Reported They Did Better Taking Their Medications: 60 – 78%

Pie Chart II

Since the initiation of the OpenNotes project in 2010, there have been several articles written.  Two, in particular, by Forbes contributor, Dave Chase, stand out:

1)      Historic Day in Opening Doctors’ Notes: this article discusses the idea of ownership, which is an ongoing debate in the healthcare industry.  Does the clinician own the information, or the patient?  Additionally, only 8% of providers noted that additional time was needed with patients outside of the actual visit due to the notes provided/written.  At the end of the project, most of the physicians chose to continue the practice of keeping their notes open and available to patients.  We learn that, ultimately, the physician is aware of the patient’s needs and preferences for OpenNotes, as well as the impact it has on the patient choosing them as their preferred provider.

2)      Patient Engagement is the Blockbuster Drug of the Century: this article shares an interview with Sherry Reynolds, a healthcare industry veteran who is well-known as a patient advocate.  She made a strong point recently on Twitter, writing: “If #OpenNotes was a new drug that increased patient engagement by 85%, every doctor in the country would be prescribing it.”

Overall, what the OpenNotes project provided was a way for providers to share patient-centric information directly with the patients, which caused more satisfied outcomes for patients.  This then leads patients to wanting visible and accessible notes, so they begin to choose care providers based on more than just word-of-mouth or an in-network status. We’ve officially stepped into the consumer phase of healthcare. Though the advantages of accessible clinician notes may not be as apparent in remote, rural areas where a struggle to move from paper and into an electronic medical record (EMR) still exists, the rewards are extremely apparent in urban and suburban areas with populations more accustomed to technology.

In most areas, we now expect that we can obtain our own information from our clinical providers. As patients, we feel that the information allows us to ensure that we are properly managing our health. A transparent record allows us to “refresh” our memory and refer back to what we think we heard in our visit. Additionally, if we see that the clinician is not providing the level of information or even the level of care that we expect, we now have lots of venues from the Web to compare clinicians, the systems they use, and how they use them.  This transparency and motivation to choose brings consumerism to the hands of the patient.

Would you look at your notes if they were available? Are you able to do so today? How much do you believe that this would affect your choices on your treatment and your provider?