In “Open Notes: Doctors and Patients Signing On,” published in the July issue of the Annals of Internal Medicine, researchers speculate about the risks and rewards of making clinicians’ notes transparent to patients.
“Opening documents that are often both highly personal and highly technical is anything but simple,” wrote 10 investigators, led by Tom Delbanco, MD and Jan Walker RN, MBA of Beth Israel Deaconess Medical Center.
They document what they have learned from preparing their ‘Open Notes’ study, in which more than 100 primary care doctors are inviting about 25,000 patients to read their notes. The 12-month trial involves doctors and patients associated with Beth Israel Deaconess Medical Center, Geisinger Health System in Pennsylvania and Harborview Medical Center in Seattle, according to a press release.
After patient encounters, doctors have long written notes ranging, “from cryptic abbreviations on an index card to lyrical essays.” Yet despite a patient’s legal right to read their doctor’s note, few do. In a world where 57% of respondents to a 2009 Pew Internet Project and the California HealthCare Foundation survey said they got medical information on the Internet, the doctor’s note is uncharted territory.
Although literature suggests that promoting active patient involvement in care may improve doctor-patient communication and clinical outcomes, both patients and doctors express everything from enthusiasm to dismay when it comes to sharing the visit note.
The study will use secure Internet portals and only include notes written during the trial period. The centers involved represent a broad array of settings, from urban and suburban practices in Boston to a rural Pennsylvania health system and a county hospital in Washington state that serves many indigent patients.
While they are gathering considerable data from the patient and doctors’ experiences during the study period, Delbanco and Walker say their ultimate question is whether the participants will want to “leave the Open Notes switch on” after 12 months.
“Open notes pose many questions and probably represents the Model-T stage of the future. Can a single note serve many different audiences, and can the push toward structure and template preserve the unique attributes of each person?”