Should Clinical Notes in Electronic Medical Records Be Open to Patients?

Let’s look at the record.

Al Smith (1973-1944),  Speech, 1928 Presidential Campaign

In these days of political scandals and Obamacare controversies, calls for more ”transparency” echo and reverberate  through the land.

A common denominator in these calls – at the State Department,  the IRS,  the White House,  and imedical orgaanizatons -  is demand for access to emails and other forms of electronic records.  

Heretofore emails and electronic medical records have been considered either private or the property of organization from which they emanated. No more.  With everybody connected electronically, everything is perceived to be an open book, and theoretically there should be no closed doors.

This is a myth. Not everything can be revealed, and some things must be kept secret to protect security and privacy  in government as well as medicine.   But in clinical medicine, it is becoming apparent some electronic clinical notes can shared  to the benefit of both patients and doctors.

In a May 14 report in HealthLeaders Media,  Scott Mace, an editor for that publication, reports  that patients and doctors  laud access to clinical notes in EHRs.   In a 2010 clinical trial, in which 105 physicians and 20,000 patients participated,  at Beth Israel Medical Center in Boston (649 licensed beds), Geisinger Health System in Pennsylvania (1363 licensed beds), and Harborview Medical Center in Seattle (413 licensed beds), patients were automatically given access to the clinical notes stored in their EHRs .

When physicians composed notes electronically, each institution’s EHR would trigger an email message letting the patient know the note was ready.  The note would say, “You have a visit coming up, and we suggest you might want to look at your last note.” Physicians had the option of participating in the OpenNotes Program, or excluding certain patients from receiving the notes. Psychiatric patients and adolescent patients, aged 12 to 17, were not included in the clinical trial.

The results of the OpenNotes program were positive:

·         70% of patients said they understood their conditions better. They said they took better care of themselves, better remembered their care plan, felt more in control, and took their medications better.

·         At Geisinger, 87% of patients said y bread every single note, and 20% reported sharing the note with someone else.

·         99% of patients said they wanted to continue to have access to clinical notes.

·         100%% of the doctors continue to participate, though 20% reported some misgivings.
 

Beth Israel and Geisinger are now in the process of expanding their OpenNotes programs.  Harborview, a a safety-net hospital, says budget concerns have prevented it from integrating the OpenNote tab into new electronic medical records.

Tweet:  A  OpenNotes program at 3 health systems permitted patients to view physicians’ clinical note was well-received by patients and  doctors.