Open Records Pilot Project Looks To Reinvigorate Patient-Physician Dialogue

John Commins, for HealthLeaders Media , June 8, 2010

Stephen Downs, an assistant vice president at RWJF and member of the foundation's Pioneer Portfolio, said that much of the debate among physicians about the value of open medical records "is largely uninformed by evidence."

"In the context of a physician's day-to-day work, opening up notes is a subtle change . . . but it could reposition notes to be for the patient instead of about the patient, which might have a powerful impact on the doctor-patient relationship and, in the long run, lead to better care," Downs said.

To collect evidence, physicians and patients will use a one-step intervention to share all encounter notes online. By contrasting the experience of trial participants with unenrolled physicians and patients, the researchers hope to measure the impact of OpenNotes through surveys of both groups of doctors and patients.

"While this intervention potentially could disrupt the current flow of primary healthcare, it holds considerable potential to transform the doctor-patient relationship," Delbanco said. "By enabling patients to read their clinicians' notes, OpenNotes may break down an important wall that currently separates patients from those who care for them. It may promote insight and shared decision-making by bringing closer together the unique expertise of the clinician and the unique understanding of himself or herself that each patient possesses."

Frampton says that hospitals don't need an expansive study or special advisors to open their medical records. "You just have to do it. What we have found with hospitals that have just done it is that none of these problems materialize," she says. "Essentially what it does is improve patient satisfaction and helps patients feel a sense of trust that there are no secrets being kept."

Frampton says a growing number of patients—particularly baby boomers—want to be informed about the care their getting. "They want to know what is in there, they want to know what the plan is and they want to know what the results are," she says. "People who don't want to see their charts just elect not to look at it if it is presented to them, and that choice needs to be presented."

Once hospitals clear the misperception of liability or 'how do I handle the patient's questions,' Frampton says it's a win-win situation. "The better informed the patient and the family are, the better equipped they are to ask educated questions and to be more compliant with treatment," she says.

What about start up costs?

"It doesn't cost any more money," Frampton says. "If you happen to have EMR and computer screens in the patient rooms, it doesn't cost any more to tilt the screen so the patient can see it."

Rather than cost, Frampton says, it's a matter of how you practice.

"The nurse has to go over the doctor's notes or the plan of treatment anyway, so there is no reason that can't be done at the bedside, out loud, and with the patient and the family following along and having an opportunity to ask questions. It's just about changing the way you handle the chart to be more open and do more things with the patient.

John Commins is a senior editor with HealthLeaders Media.

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