Thursday, August 28, 2014

Open Notes? Absolutely.

Figure from Open Notes study illustrating access to doctors' notes found here

I enjoy reading Dr. Fred Pelzman's blog over at MedPage Today. Read this from MedPage Today:
Fred N. Pelzman, MD, a primary care physician at Weill Cornell Internal Medicine Associates, writes a weekly blog for MedPage Today, and in his spare moments he reads about what's going on in the world of primary care medicine. Take a few minutes to check out Pelzman's Picks -- a compilation of links to blogs, articles, tweets, journal studies, opinion pieces, and news briefs related to primary care that caught his eye.
His Pelzman's Picks interest me, and one link from yesterday was particularly engaging entitled When Patients Read What Their Doctors Write  and published on NPR's health news page. Here's a snippet:
The woman was sitting on a gurney in the emergency room, and I was facing her, typing. I had just written about her abdominal pain when she posed a question I'd never been asked before: "May I take a look at what you're writing?" 
At the time, I was a fourth-year medical resident in Boston. In our ER, doctors routinely typed visit notes, placed orders and checked past records while we were in patients' rooms. To maintain at least some eye contact, we faced our patients, with the computer between us. 
But there was no reason why we couldn't be on the same side of the computer screen. I sat down next to her and showed her what I was typing. She began pointing out changes....continue reading here
The author of the piece, Dr. Leana Wen, an attending physician and director of patient-centered care research in the Department of Emergency Medicine at George Washington University, went on to comment about the concept of giving patients access to the information in their charts, specifically the doctor's documentation about a visit or exam. You can read more about this practice inspired by a study published in the Annals of Internal Medicine in 2010 conducted by a team of physicians and nurse researchers here: Open Notes: Doctors and Patients Signing On:
Few patients read their doctors' notes, despite having the legal right to do so. As information technology makes medical records more accessible and society calls for greater transparency, patients' interest in reading their doctors' notes may increase. Inviting patients to review these notes could improve understanding of their health, foster productive communication, stimulate shared decision making, and ultimately lead to better outcomes. Yet, easy access to doctors' notes could have negative consequences, such as confusing or worrying patients and complicating rather than improving patient–doctor communication. To gain evidence about the feasibility, benefits, and harms of providing patients ready access to electronic doctors' notes, a team of physicians and nurses have embarked on a demonstration and evaluation of a project called OpenNotes. The authors describe the intervention and share what they learned from conversations with doctors and patients during the planning stages. The team anticipates that “open notes” will spread and suggests that over time, if drafted collaboratively and signed by both doctors and patients, they might evolve to become contracts for care. [Bolding mine] Continue reading here
I would agree completely with the team's anticipation of a shared plan of action which includes input from both clinician and patient. One of the reasons this study and it's commentary caught my interest was the fact that this is how my rheumatologist Dr. Young Guy conducts all of our visits. I can read the text of his entries into my chart online soon after the visit. My new internal medicine physician does this as well. If I have trouble recalling exactly what was discussed, the doctor's note appears in my after visit summary that I can view online or receive a paper copy when I leave the appointment.

I appreciate this now more than ever. I do view my medical care as a collaborative process and I never have to wonder how I am being assessed and what conclusions and plans are reached by physicians and other health care providers since it's all there for me to see. Most of my lab and test results are there as well, and if they're not I know that I will be receiving a phone call explaining the results with a follow up letter stating the same info.

Not all physicians in my medical services provider system follow their example, however. I'm delighted that my doctors do -- and I hope that others see the benefit of active patient involvement and will begin sharing their documentation as well.

Does your physician enter information about your visits on a computer in the exam room? Are you able to see and discuss what is being entered in your medical record? And if not.....

.....are you considering asking why not?


Heda said...

My wonderful doc who has serum negative rheumatoid arthritis makes sure I am on the mailing list to receive a copy of all tests I might have done. Sometimes she scares me a bit because she assumes I know a lot more about my condition than I actually do. I like to think I'm informed but my knowledge doesn't compare with the knowledge of a qualified health practitioner who has treated me for over 20 years. She is my rock in this sea of chronic illness and I know that I am lucky.

Betsi said...

This is a growing trend, and a welcome one. The results of my tests are displayed with the visit summary online a day or two after I see the doctor. My daughter's -- she has lupus -- show up right after the tests, before she's spoken to the doctor, and I think that's a mistake. She's free to interpret them herself, and does!

My OB/GYN, who retired a couple years ago, always sat beside me and showed me what he was writing in his notes. Although he feared the mandated switch to PC's was going to put a buffer between him and his patients, he was able to do basically the same thing he always had.

Anonymous said...

My doctor just recently switched to electronic records, and we get access to a summary of notes through a web patient portal. I have noticed some weird mistakes - they say that we talked about things that we didn't, or the system says I have a history of something and I don't. I think the doctors are clicking buttons during the patient interview and sometimes hit the wrong one. So far there is no mechanism to fix the mistakes, but hopefully in the future there will be.