Letters: Better access to doctor's notes comes with some caveats

Regarding the article “More U.S. patients to have easy, free access to doctor’s notes,” as a health researcher and public health advocate, I am thrilled that providers will be required to share their notes with patients. When patients know what their doctors say about them, they are more engaged in and satisfied with their care.

To the extent these notes are ever made broadly available to researchers in a de-identified manner, the possibilities are endless. Researchers could use natural language processing and other analytic methods to assess new dimensions of the patient/clinician relationship and associated clinical outcomes.

But to be clear, there is nothing easy about this change. In as much as this development could be a boon for patient agency and offer interesting research pathways, there are many land mines. In the analytics field we often see data-rich, information-poor environments, or scenarios where organizations possess ample data without background, sense of accuracy or uniformity. Without careful context and consistent data-collection protocols, data can be meaningless or, even worse, misleading.

Whenever we undertake a new research project, we must develop a data dictionary to know what we are looking at and how it was developed. As clinician notes become more broadly accessible, it is incumbent upon healthcare organizations to ensure that patients are not simply sent an electronic link to notes, but are armed with easy access to data dictionaries and, ideally, resources and contacts to ask questions.

Even better, enable patients to record their own observations in the notes. The work led through the Open Notes movement is a great place to start to ensure that patients have knowledge and information, not just data.

Jessica Steier, DrPH
CEO
Vital Statistics Consulting 
Maplewood, N.J.

“CMS approves Georgia’s reinsurance plan, exiting HealthCare.gov for 2023 coverage” was helpful and balanced. But having seen the situation up close, more needs to be said.

A total of 38 states, red and blue, have already expanded their Medicaid programs, bringing the U.S. rate of uninsured down to 9.2%. But not Georgia, with the third-highest uninsured rate in the nation at 13.7%.

Georgia has 1.4 million residents without health insurance. Why is the state so high compared with other states? Because the governor and Legislature have refused to accept federal dollars to expand the Medicaid program (which would have been 100% paid by the feds for the first three years had we done so a decade ago). Estimates are that an additional 567,000 low-income Georgians would get Medicaid coverage if the program were simply expanded now rather than going through the waiver process.

The ideological basis for Georgia’s earlier 1115 waiver is that to obtain Medicaid coverage a person must be employed, even during the current depressed economy, with the unemployment rate at high levels not seen in over a decade. This goes against both the spirit and wording of the Affordable Care Act, designed to improve coverage for low-income individuals and families.

Georgia’s recently approved 1332 waiver restructures the state’s health insurance market. It erases the health insurance marketplace to obtain coverage, which will inevitably lead to consumer confusion and is predicted to substantially reduce the number of people covered. Again, this is against the spirit and wording of the ACA.

Specifically, to find full ACA coverage now, people simply need to go to HealthCare.gov. Gov. Brian Kemp’s plan sets up a confusing Georgia-specific system, which would be driven by for-profit insurance companies and brokers, containing substandard, noncompliant plans. Such plans often do not contain the ACA’s legally mandated “essential health benefits,” failing to cover prescription drugs, mental health services, maternity care and other critical services.

Jack Bernard
Peachtree City, Ga.