Recent discussions about how electronic health records can improve healthcare delivery mainly have focused on the impact on hospitals, physicians, or nurses. Missing from this lineup: patients. A one-year pilot called OpenNotes, however, is aiming to get patients more involved in their care by letting them read their primary care physicians' visit notes online through secure Websites.
"Patients say that they're really interested in this by and large. But, one of the questions is if we open these records, will they look at them?" says Jan Walker, RN, MBA, a health services researcher at Beth Israel Deaconess Medical Center, Boston, and one of the study's lead investigators. "So thanks to computer systems, we can find out."
The study, outlined in the July 20 Annals of Internal Medicine, involves about 100 primary care physicians—who volunteered for the OpenNotes project—at three diverse organizations: Beth Israel Deaconess, an urban academic health center with community practices; Geisinger Health System, an integrated health system in rural Pennsylvania; and Harborview Medical Center, a county hospital in Seattle which serves many homeless and indigent patients.
About 30,000 patients—members of their physicians' panels--are expected to participate during a one-year period. Patients of participating physicians are alerted by e-mail when their physicians' notes are available.
Beth Israel and Geisinger, which started their OpenNote initiatives in May and July respectively, have secure, established electronic portals. Harborview Medical Center will offer its patients access to a secure online portal for the first time in September.
As expected, quite a few primary care physicians approached about the OpenNotes project expressed reservations. At the top of the list of their concerns was the effect on their time—particularly if overwhelming numbers of patients would contact them through phone calls, letters or e-mails if they had questions or comments.
Other physicians thought they would have to write notes that would be scientifically imprecise—leaving out important diagnostic and therapeutic considerations—in order to be understood by patients. Other physicians noted that they were embarrassed by their writing or uncomfortable with their typos--making them seem less professional, the researchers found.
And then, then there were those abbreviations that were confusing or likely to draw their patients' ire—such as "SOB," which in a clinical context means "shortness of breath."
Others are looking at OpenNotes as a way for patients to get something extra out of their care. Another researcher who assisted with the study, Henry Feldman, MD, says, "I wanted to do this because in Massachusetts—for a long time—we've had this rule that patients should have access to their healthcare records, but we make it very hard for them."
Feldman, who currently holds dual appointments as a hospitalist and as the chief information architect with the Division of Clinical Informatics at Beth Israel, says the "most underutilized resource" in the healthcare system is the patient.