OpenNotes

The OpenNotes project has launched with the goal of evaluating transparency in primary care through on-line sharing of encounter notes between patients and their physicians.

The July 20th Annals of Internal Medicine reports that "few patients read their doctors' notes, despite having the legal right to do so. As information technology makes medical records more accessible and society calls for greater transparency, patients' interest in reading their doctors' notes may increase. Inviting patients to review these notes could improve understanding of their health, foster productive communication, stimulate shared decision making, and ultimately lead to better outcomes. Yet, easy access to doctors' notes could have negative consequences, such as confusing or worrying patients and complicating rather than improving patient–doctor communication. To gain evidence about the feasibility, benefits, and harms of providing patients ready access to electronic doctors' notes, a team of physicians and nurses have embarked on a demonstration and evaluation of a project called OpenNotes."

Participants include 100+ primary care physicians and 25,000 patients from Beth Israel Deaconess Medical Center (BIDMC) in Boston, Geisinger Health System (GHS) in rural Pennsylvania, and Harborview Medical Center (HMC) in Seattle.

"As the general trend toward transparency accelerates, hospitals and health care systems with electronic medical records increasingly allow patients to view laboratory results, medication lists, and other parts of the medical record. However, though patients own their medical records, they rarely have easy access to the notes written about them by doctors and others. OpenNotes is a simple, but potentially disruptive intervention that aims to transform the patient-clinician relationship as it furthers both transparency and the democratization of health care. The "bottom line" evaluation of OpenNotes is straightforward: Will patients and doctors want to continue when the study period ends?

During the 12 months of the study, patients are invited to read the notes their PCPs write following office visits, e-mail correspondence, and phone calls. They can view these notes in their medical records via the secure websites where they can also view other portions of their medical records – PatientSite at BIDMC, and MyGeisinger at GHS. At Harborview, OpenNotes patients are the first to view notes and other parts of their records via HealthReach, Harborview's new portal

Once the PCP writes and signs a note after an encounter, the note is "opened," and patients receive an e-mail message announcing its availability. Shortly before his/her next scheduled appointment, the patient receives another message suggesting that s/he review the note in preparation for the visit."