Inviting Patients to Read Their Doctors' Notes: Patients and Doctors Look Ahead

Abstract

Background Little is known about what primary care physicians (PCPs) and patients would expect if patients were invited to read their doctors' office notes. Objective To explore attitudes toward potential benefits or harms if PCPs offered patients ready access to visit notes. Design The PCPs and patients completed surveys before joining a voluntary program that provided electronic links to doctors' notes. Setting Primary care practices in 3 U.S. states. Participants Participating and nonparticipating PCPs and adult patients at primary care practices in Massachusetts, Pennsylvania, and Washington. Measurements Doctors' and patients' attitudes toward and expectations of open visit notes, their ideas about the potential benefits and risks, and demographic characteristics. Results 110 of 114 participating PCPs (96%), 63 of 140 nonparticipating PCPs (45%), and 37 856 of 90 826 patients (42%) completed surveys. Overall, 69% to 81% of participating PCPs across the 3 sites and 92% to 97% of patients thought open visit notes were a good idea, compared with 16% to 33% of nonparticipating PCPs. Similarly, participating PCPs and patients generally agreed with statements about potential benefits of open visit notes, whereas nonparticipating PCPs were less likely to agree. Among participating PCPs, 74% to 92% anticipated improved communication and patient education, in contrast to 45% to 67% of nonparticipating PCPs. More than one half of participating PCPs (50% to 58%) and most nonparticipating PCPs (88% to 92%) expected that open visit notes would result in greater worry among patients; far fewer patients concurred (12% to 16%). Thirty-six percent to 50% of participating PCPs and 83% to 84% of nonparticipating PCPs anticipated more patient questions between visits. Few PCPs (0% to 33%) anticipated increased risk for lawsuits. Patient enthusiasm extended across age, education, and health status, and 22% anticipated sharing visit notes with others, including other doctors. Limitations Access to electronic patient portals is not widespread, and participation was limited to patients using such portals. Response rates were higher among participating PCPs than nonparticipating PCPs; many participating PCPs had small patient panels. Conclusion Among PCPs, opinions about open visit notes varied widely in terms of predicting the effect on their practices and benefits for patients. In contrast, patients expressed considerable enthusiasm and few fears, anticipating both improved understanding and more involvement in care. Sharing visit notes has broad implications for quality of care, privacy, and shared accountability.

Despite Substantial Progress In EHR Adoption, Health Information Exchange And Patient Engagement Remain Low In Office Settings

“…23,24 Second, physicians may worry that patient portals might generate a large volume of clinical issues that require responses (time for which the physician cannot bill). 25 And finally, some providers are concerned that accessing these data might make patients confused or worried.…”

Interval Examination: Moving Toward Open Notes

“…[17][18][19][20] In brief, we learned that patients were enthusiastic about the experience and reported potentially important clinical benefits, such as improved recall and understanding of their care plan, improved adherence to their medications, and feeling more in control of their care. We found that doctors were surprised by how few patients appeared troubled by what they read and how little effect the intervention had on the PCPs' work lives.…”

Electronic Health Record Management: Expectations, Issues, and Challenges

“…Population-based surveys suggest that patients desire online access to their medical records and email communication with clinicians [21]. Patients expect the capability of controlling accesses to their data and hiding some of their data from health care practitioners.…”

“…Reports show that 80% of health care personnel use their smartphones for workrelated tasks [20,21]. The system thus becomes an environment, where a whole ecology of applications may be coexisting in the device opening the door to many unintentional but malicious threats [22].…”