A total of 105 primary care physicians from the three institutions volunteered to participate in the 2010 trial. About 20,000 patients overall were automatically given access to the clinical notes stored in their electronic medical records, says Jan Walker, RN, MBA, coprincipal investigator with Tom Delbanco, MD, of OpenNotes at BIDMC and Harvard Medical School.
When physicians would compose notes electronically, each institution's EHRs would automatically trigger an email message to the patient, letting him or her know the note was ready.
"Two weeks before the next visit, we sent them another message saying 'You have a visit coming up, and we suggest you might want to look at your last note, just to refresh your memory,' " Walker says.
Doctors who signed up were initially skeptical about the impact of OpenNotes on their workflow and the effect on their patients. "They were pretty worried that patients reading their notes would trigger an avalanche of questions—emails, telephone calls—that they just didn't have the time to deal with," Walker says. "And then they were also worried that patients would be worried or confused or upset by reading their notes."
After the 12-month experiment, the results were positive: more than 80% of patients who had visited and thus generated a clinical note, had viewed at least one of the notes written during that time. "On the doctor side, they found that those worries about questions and patients being worried basically didn't materialize," Walker says. More than 70% of patients reported that they understood their medical conditions better. "They said they took better care of themselves, they better remembered their plan of care, they felt more in control, and about two-thirds of the patients taking medications said they were taking their medications better."
At all three institutions, researchers asked patients if they wanted to continue to have access to their clinical notes, and 99% in all three places said they did, Walker says. "I've never done a survey before where 99% of people said anything."