Healthcare News & Insights

Can sharing medical notes online with patients improve outcomes?

When patients are hospitalized, remembering everything their physicians tell them can be overwhelming. And once they’re discharged, it’s easy to forget a lot of that information. But what if patients had access to their physicians’ medical notes online: Would they follow their post-care instructions better and be less likely to be readmitted?

It’s a definite possibility.

A recent study published in the Annals of Internal Medicine looked at the effect on doctors and patients of facilitating patient access to visit notes over secure Internet portals.

While all patients are allowed by federal law to see their medical notes, very few request to see them. However, in the study, 90% of the patients looked at their doctors’ notes when they were offered online access to them. And at the end of the study, 99% of participating patients said they wanted continued access to their medical notes.

Greater understanding of medical issues

The study included 105 primary care physicians (PCPs) with practices at Beth Israel Deaconess Medical Center (BIDMC), Boston;  Geisinger Health System (GHS), Danville, PA; and Harborview Medical Center (HMC), Seattle.  It also included 13,564 patients who had at least one medical note during the period of the study.

Of those patients, 11,797  opened at least one note. But what really gave the study authors insight were the 4,391 patients who opened at least one note and completed a post-intervention survey. These patients reported:

  • the notes helped them feel more in control of their care (77% to 87% across the three sites), and
  • increased medication adherence (60% to 78%).

However, 26% to 36% of patients reported they had privacy concerns and 1% to 8% said the notes confused, worried or offended them.

Offending patients certainly isn’t a positive and may cause physicians to soften their language, which could have a clinical impact since physicians share the same notes. But one woman reported that after reading in her medical note that the doctor called her “mildly obese,” she ran straight out and joined Weight Watchers and started a daily exercise program. She said she hadn’t realized she had gained that much weight and was bound and determined to change that by her next check up.

As for the doctors, they most frequently commented:

  • the online notes strengthened relationships with some of their patients (including enhanced transparency, communication and shared decision making)
  • some patients seemed more activated or empowered, and
  • the shared notes may have improved patient satisfaction, patient safety and the opportunity for patient education.

Also, of the participating physicians, 85% at BIDMC, 91% at GHS and 88% at HMC said they thought making the visit notes available to patients online “is a good idea.” Although some did raise concerns over privacy issues — mainly patients sharing their results with others.

Powerful incentive

It would seem the open notes proved to be a powerful tool for improving the health of patients and strengthening the doctor/patient relationship.

And after reviewing their individual results, the three participating institutions decided to broaden patient access to their clinicians’ notes.

While this study looked at PCPs, there doesn’t appear to be any reason why the results couldn’t be duplicated by hospital physicians. Just think if the physicians at your hospital could get better after-care compliance from patients. Maybe open notes could actually keep patients healthier and reduce your readmission rate.

If your physicians balk at the idea, you can let them know that the majority of the physicians in the study (74%) reported that nothing was difficult about the open notes program and they experienced no changes in their practice.

Note: The study was funded by The Robert Wood Johnson Foundation.

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