In an episode of the television show “Seinfeld,” the character Elaine discovers that she is described as a difficult patient” in her doctor’s notes after reading her chart in the examination room. Much of the episode surrounds her quest to have this notation stricken from her medical record, but much to her chagrin it follows her from doctor to doctor. What if clinician’s notes were not shielded from the patient, but instead shared?
A movement called OpenNotes stems from the results of a demonstration and evaluation project of 105 primary care physicians and >19,000 patients in which physician notes were available via patient portals. The participating physicians were allowed to exclude patients from the study, such as those with major mental illness or substance misuse. The notes were available in the secure portals following a visit and reminders were sent prior to the next scheduled visit to encourage the patient to review the notes in preparation.
During the 12 month study, over 80% of patients opened at least one note and more than two-thirds reported a greater understanding of their health and medical conditions, the importance of lifestyle and behavioral changes, and medication adherence. Only 1–8% of patients at the three sites were confused, worried, or offended by the content in the notes and over 85% felt that the availability of the notes would influence their future choice of providers.
Although some physicians had concerns that the shared notes would lead to additional time spent answering patient questions outside of visits, just 3% of the study doctors reported that this occurred; 11% spent more time writing or editing notes but the volume of emails were unchanged. Despite this, many clinicians still have concerns regarding additional time needed to compose notes that the patient will be able to understand, patient requests for changes to notes, creating patient fears, and adapting medical language for patients in a way that does not undermine efficient communication between clinicians. More studies are needed on ways to minimize these concerns, but some professional groupssuch as the American College of Physicians have already given the OpenNotes movement their seal of approval.
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