Impacts and Concerns of OpenNotes

credit: OpenNotes

As physicians, you want to clearly communicate information to your patient.  This information could range from simple lifestyle changes brought up at a patient’s yearly physical, to life-altering discussions with a cancer patient.

OpenNotes invites patients to review their physician’s visit notes online with the goal of keeping patients better informed and actively involved with their health.  Dr Tom Delbanco of Beth Israel Deaconess Medical Center is a proponent of OpenNotes, saying that it “creates partnerships toward better health and health care by giving everyone on the medical team, including the patient, access to the same information”.

While the pros of this initiative are obvious, physicians have several key concerns worth considering – additional time, the risk of misunderstanding physician notes, and concern about confusing or causing additional worry from patients.

Additional Time

Additional calls, letters and emails causing a drain on a physician’s time was the biggest worry.  Jennifer Potter, a Beth Israel physician, declined to participate in the original OpenNotes study due to time constraints.  Her position was that “theoretically it sounds wonderful for patients to be able to access their entire medical record, but with so many doctors leaving primary care because they can’t manage the loads they already have, it’s just an added burden.”

Misunderstanding Doctor-Speak

Physicians often use shorthand in their notes which can be confusing to patients.  For instance, when a doctor writes “SOB”, a medical professional understands they’re referencing “shortness of breath”…not calling the patient a derogatory term.  Other shorthand terms that could be misconstrued are demented (medical term for memory loss or inability to learn new materials), patient denies (patient reports no symptom), or shotty (mildly enlarged lymph nodes).

Confusing Patients and Causing Additional Worry

Some physicians worry they would need to omit important diagnostic and therapeutic comments that speculate more serious diseases as to not cause the patient to panic.  Other confusion could arise from misunderstood diagnoses.  For example, a patient who sees congestive heart failure (a manageable heart condition – not literal failure) in their chart but doesn’t know what it is, could become anxious.

Even with these reservations, is keeping physicians, patients and their families on the same page about a person’s health worth the risk of a periodic misunderstanding and a little extra time?

Early Adopters Found Success with OpenNotes

Since 2010, primary care doctors at three major health centers volunteered to use OpenNotes, and allow their patients to read their visit notes online.  At the end of the trial, not one of the 105 primary care doctors at Beth Israel Deaconess Medical Center elected to stop providing access to notes, and 99% of the patients participating decided to stay with the program.  Patients felt more in control of their care, understanding their medical issues better and were more likely to take their medications as prescribed.

There was also good news for physicians.  Most of the participating doctors reported that their fears of an additional time burden and offending or worrying patients did not materialize.  21% reported taking more time to write notes, 8% spent extra time addressing patient questions outside of visits, and only 5% said they had longer patient visits.

Have you used OpenNotes?  Was your experience positive or negative?  Is it something that you’re exploring for your practice for 2014?  We’d love to hear your thoughts below and if you’re an M.D. or D.O. we’ll be continuing the conversation inside Sermo.