Most physicians who let patients read their notes over the course of a year as part of a study concluded that the practice was a good idea, and most patients in the study said the experience increased their medication adherence, according to a report in the Annals of Internal Medicine.
The Robert Wood Johnson Foundation-funded study
included 105 doctors and more than 13,500 patients at Beth Israel Deaconess Medical Center, Boston; Geisinger Health System, Danville, Pa.; and Harborview Medical Center, a Seattle safety-net hospital. Before the study began, a preliminary survey about doctor note-sharing
was conducted. That survey found enthusiasm from patients for the practice but concern among physicians that letting patients see doctors' notes would lead to longer visits and more patient demands between visits. Some physicians also were concerned about expressing candid comments regarding patients' mental health, substance abuse, cancer and obesity. (Some 1,000 Harborview patients were excluded from the follow-up survey where mental illness or substance use was their main reason for receiving medical care.)
Participants were surveyed online last fall following 12 to 19 months of experience with open-note access. The study was led by Dr. Tom Delbanco
and nurse Jan Walker from Beth Israel and Harvard Medical Center.
Of the 13,564 patients, 11,797 opened at least one note. This included 84% of the participants at Beth Israel, 92% at Geisinger and 47% at Harborview. Patients were notified when doctors entered a note, but defects with the Harborview system resulted in only 49% of notes triggering notification e-mails, according to the report. The most common (33%) reason for not opening notes was "forgot notes were available online."
Across the three sites, 60% to 78% of responding patients said their adherence to their medication regimen improved. “Having it written down, it's almost like there's another person telling you to take your meds," reported one patient. Another patient, after reading that the doctor had called the patient "mildly obese," reported immediately enrolling in Weight Watchers and starting daily exercise, the report said.
Also, 86% of the respondents at Beth Israel, 87% at Geisinger, and 89% at Harborview said that access to visit notes would be a somewhat or very important factor in choosing a future doctor or health plan.
For doctors, 85% at Beth Israel, 91% at Geisinger and 88% at Harborview concluded that making visit notes available "is a good idea." Generally, only about half as many physicians as patients thought patients had benefited from the experience, but the report noted that many of these doctors responded by saying they didn't know.
"The study findings suggest that open notes may be a powerful intervention for improving the health of patients and point to many avenues for future elaboration and inquiry," the study authors concluded. "In response to a relatively simple intervention, the patients in this large-scale trial reported striking benefits and presented a clear mandate to continue open notes. The doctors encountered few problems, and we hope that the problems that exist can be overcome with further analysis, education, and experimentation."