By Jan Walker, RN, MBA, and Suzanne Leveille, RN, PhD, of OpenNotes

This is cross-posted from ADVANCE Perspective: Nurses

 As nurses, we've always been focused on the patient. Teaching patients about their health and advocating for patients are both incredibly important parts of the job. That's why we got involved with OpenNotes-an initiative that invites patients to review the visit notes written by their doctors, nurses, or other clinicians.

Health care is one of life’s most basic needs. It’s so simple. In recent years, though, the subject of health care has also served to polarize our nation. We all need it, but who’s responsible for making sure we get it? How do we ensure it’s safe, high-quality care? What about cost? Vocal, contentious debate over the answers to these questions—and many more—continues unabated in the United States. Meanwhile, in my work as a volunteer nurse at a clinic for the uninsured, I see patients who continue to lack the means to get even the most basic of care, who struggle with chronic disease in a system that seems to throw up obstacles at every turn.

That’s the bad news.

Here’s the good news: Amidst the unproductive noise, countless innovators from all walks of life are quietly going about the work of solving some of the most intractable problems in health and health care. 

By Glenn D. Steele Jr., MD, CEO of Geisinger Health System

A group of health leaders, consumer advocates, and medical professionals are gathering in Washington, D.C., today to advance a simple idea that I see as transformational—having doctors make medical notes available to their patients so they can become more engaged in their care. As a health system CEO who also is a doctor, I believe it is an ethical imperative that our patients at Geisinger know everything that we know about them. And, I think it’s a logical imperative that if we can open up our medical visit notes to our patients, we’ll find out what they understand and what they don’t, so we can answer questions and work as partners to chart a path to better health.

The idea of open medical notes is not just an interesting theory. Geisinger just participated in a year-long study called OpenNotes with Beth Israel Deaconess Medical Center in Boston and Harborview Medical Center in Seattle in which more than 100 primary care doctors invited more than 13,000 patients to see their doctors’ notes. The evidence, published last week in the Annals of Internal Medicine, makes clear that open notes is something patients want, something they use, and something that doesn’t unduly burden doctors. In fact, it also is something that could lead to better care and potentially could save health care dollars—as many as 70 percent of patients said that having access to their own visit notes prompted them to adhere to the medications their doctors prescribed.

Last week, I had a flashback to a Saturday night in 2010, when I was in my last semester as a second-career nursing student.

It was a beautiful spring night and my family was gathered around a bonfire in the backyard. I, on the other hand, was sitting at the kitchen table, still in my scrubs. My laptop open, I was staring at the blinking cursor. As usual, I was struggling to finish my “patient database”—my school’s version of a nurse’s note about what happened, clinically, with my assigned patient that day:

1430: Patient received drowsy but AOx3. MAE, equal strength. Primary nurse reports patient requires one-person assist OOB to chair; patient not OOB this shift. PERRLA. Skin is warm & dry, no bruising noted. IV site (20 g left outer forearm) is clean, dry and intact; no pain or erythema noted. Capillary refill <3 sec. Heart sounds audible and regular. Radial and pedal pulses present & equal bilaterally. No edema noted. RR 16, unlabored. SAO2 94% on room air…

Originally posted on The Health Care Blog.

A few years ago, Tom Delbanco and Jan Walker pitched us with a simple idea: Patients should routinely be able to see the notes that physicians write about them.  Now it’s true that we all have the legal right to see these notes, but obtaining them is anything but routine. The process involves phone calls, faxes (sic), duplicating fees and all sorts of other demoralizing steps. The net result is that reviewing your doctor’s notes about you is a rare experience.

Tom and Jan said that the physicians with whom they had spoken about this idea were split. Some were interested, some were resigned: They recognized that transparency was an increasingly powerful wave and that the world seemed to be heading this way, and the others thought they were crazy—notes were for documentation and communication among doctors and were never intended for patients.  The arguments were of a religious quality—they were about belief and values.  The obvious solution was to test the idea and let data help sort it out.  Today, with the publication of the study results in the Annals of Internal Medicine, that debate is now illuminated.