Resident and Attending Physicians’ Perceptions of Patient Access to Provider Notes: Comparison of Perceptions Prior to Pilot Implementation

Abstract

BackgroundAs electronic health records have become a more integral part of a physician’s daily life, new electronic health record tools will continue to be rolled out to trainees. Patient access to provider notes is becoming a more widespread practice because this has been shown to increase patient empowerment.ObjectiveIn this analysis, we compared differences between resident and attending physicians’ perceptions prior to implementation of patient access to provider notes to facilitate optimal use of electronic health record features and as a potential for patient empowerment.MethodsThis was a single-site study within an academic internal medicine program. Prior to implementation of patient access to provider notes, we surveyed resident and attending physicians to assess differences in perceptions of this new electronic health record tool using an open access survey provided by OpenNotes.ResultsWe surveyed 37% (20/54 total) of resident physicians and obtained a 100% response rate and 72% (31/44 total) of attending physicians. Similarities between the groups included concerns about documenting sensitive topics and anticipation of improved patient engagement. Compared with attending physicians, resident physicians were more concerned about litigation, discussing weight, offending patients, and communicated less overall with patients through electronic health record.ConclusionsPatient access to provider notes has the potential to empower patients but concerns of the resident physicians need to be validated and addressed prior to its utilization.

Changes in Clinician Attitudes Toward Sharing Visit Notes: Surveys Pre-and Post-Implementation

“…One web-based training program for mental health clinicians on open notes resulted in a small but significant reduction in clinicians’ worry about the negative consequences. 28 Such programs could be extended to other clinicians including trainees, a group particularly concerned about the negative impacts of open notes including potential litigation, offending patients, 9 and harming the patient-physician relationship. 29 …”

“…In studies of resident physicians anticipating open notes, just over half thought sharing notes with patients online was beneficial overall, 8 citing both potential benefits and drawbacks, including worry about overwhelming patients, potential litigation, clinician workload, and offending patients. 8 , 9 Qualitative studies among specialists found concern about potential loss of note integrity and patient exposure to sensitive content. 10 , 11 Other clinician evaluations have been hampered by low response rates.…”

Attitudes and Experiences of Clinicians After Mandated Implementation of Open Notes by the 21st Century Cures Act: Survey Study

“…These are confined to a few medical specialties, anticipatory studies, and studies conducted within health systems that voluntarily began sharing clinical notes. Although physicians anticipated improved patient engagement from note sharing, conflicting attitudes were also reported [12][13][14]; for example, surveys with clinician specialists revealed concerns about the impact on documentation, specifically, modifying the tone and including fewer details [15][16][17]. In addition, a fear of potentially harming the physician-patient relationship [12,13] or causing greater patient worry [12,14] was reported.…”

“…Although physicians anticipated improved patient engagement from note sharing, conflicting attitudes were also reported [12][13][14]; for example, surveys with clinician specialists revealed concerns about the impact on documentation, specifically, modifying the tone and including fewer details [15][16][17]. In addition, a fear of potentially harming the physician-patient relationship [12,13] or causing greater patient worry [12,14] was reported. Two interdisciplinary studies examining clinician attitudes toward sharing visit notes revealed that most of the clinicians considered the practice to be a good idea [18,19].…”

The importance of the patient’s voice in nuclear cardiology

“…In a recently published survey of resident and attending physicians, 27% were concerned that patients' open access to notes would increase the risk of lawsuits and 46% reported that it would change their documentation habits. 5 In a qualitative study of primary care physicians, a number of concerns about open access to health information were raised, including generating unreimbursed workload and patient confusion. 6 In a healthcare environment where burnout rates remain over 40%, adding to physician workload is an understandable concern.…”