"Some of the explanation is that folks are used to figuring out how to get information about health, but not from their physician, so if they can't understand something, instead of asking their doc, they ask their cousin the radiology tech, or their brother-in-law who's a nurse, or whatever," Darer says. "People are more savvy than we give them credit for."
Darer says patients pointed out occasional errors left in the notes by physicians. "Doctors are not perfect," he says. "We're human. The patients would sometimes comment, 'By the way doctor, it wasn't my left knee, it was my right knee.' And I never had a single physician feel like that was a bad call. They always felt like it added value. The chart was safer."
For several kinds of patients, OpenNotes will be slow in coming. Darer describes four categories of exceptions.
"Psychiatry is certainly one of them," he says. "There are three others that come to mind very quickly. One is there are concerns about child abuse. We're going live in the pediatric arena, and that's just very sensitive, and nobody's comfortable at this point lighting those notes up. The other is the interesting, fascinating area of care of adolescents, where at a certain point, parents are asked to leave the room, because this growing young adult can then ask questions of the physician without having their parent there, and we don't want the notion that the parent might be able to see the note to inhibit the kid from asking whatever it is they want, so we're going to exclude patients between the ages of 12 and 17, so that there's just no question that the parents would be able to see anything at that point."
Finally, there is a concern about doctors administering therapy for pain. "It's a less simple relationship with some of their patients due to the issues around potential drug-seeking behavior," Darer says.