Monday, October 8, 2012

Inviting Patients to Read Their Doctors' Notes

Electronic medical records have many purported benefits. Now, access by patients to their medical record may be added to the list.  He is an article published in the Annals of Internal Medicine (free, full text) of a year long trial that provided patients with electronic links to their doctors' notes.

11,797 of 13,564 patients with visit notes available opened at least 1 note. 5391 patients completed a post-intervention survey. The majority of the survey respondents (87%) reported that open notes helped them feel more in control of their care; 60% to 78% of those taking medications reported increased medication adherence; 26% to 36% had privacy concerns and 1% to 8% reported that the notes caused confusion, worry, or offense. 

On the provider end, few doctors reported longer visits (0% to 5%) or more time addressing patients' questions outside of visits (0% to 8%).

At the study's end, 99% of patients wanted open notes to continue and no doctor elected to stop.The majority of the patients reported an increased sense of control, a greater understanding of their medical issues, improved understanding of their plan of care, and greater likelihood to take their medications as prescribed. 

This is all very positive initial data but it falls short of answering the coveted final question; will it actually result in sustained improvements in patient outcome? In other words, by opening the medical record to patients, will they be sufficiently motivated to take medications as prescribed, undergo diagnostic and screening testing, lose weight, quit smoking etc?

My hope is that as we open up the medical record to patients, that we attempt to measure improvements in care and outcome.

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