Bringing OpenNotes to Geisinger

May 20, 2013, 12:59 PM, Posted by Steve Downs

Doctor listening to man's breathing

In a post this week on the Kevin MD blog, Jon Darer, chief innovation officer for the Division of Clinical Innovation at Geisinger Health System, discussed Geisinger's decision to roll out OpenNotes to most of its physicians and patients.

Geisinger's approach highlights the choices that will be facing many health systems: The results of the OpenNotes study, published last fall, provide compelling evidence to go forward in general, but there is a need to be careful and thoughtful about how to do so. Different specialties and different patient populations have special circumstances that need careful consideration. And each institution has its own culture to be navigated. As more early adopters like Geisinger move forward, we'll learn more about how best to implement this practice and through that learning, make it more widely available. — Steve Downs

This week, over 520 of our doctors began sharing their office visit notes with patients.

All primary care doctors and general pediatricians, and selected physicians within pediatric subspecialties, dermatology, endocrinology, pulmonology, nephrology, rheumatology, cardiology, cardiothoracic surgery, vascular surgery, neurosurgery, and women’s health—including obstetrics and gynecology and gynecologic oncology—are participating in OpenNotes.

That means tens of thousands of our patients will have access to the notes doctors write about them. After each visit to their doctor, patients will get an email inviting them to read their doctors’ notes via the secure MyGeisinger online patient portal.

Giving patients easy access to their doctors’ notes can be a powerful tool for getting patients involved in their own care. It can help them remember more of what was discussed during their appointments and better understand their conditions and follow care instructions.

How did we get here?

Geisinger was one of three study sites that participated in a one-year trial of OpenNotes, supported by the Robert Wood Johnson Foundation. Over 12 months, 24 primary care physicians from Geisinger, along with 81 doctors from Beth Israel Deaconess Medical Center in Boston and Harborview Medical Center in Seattle, shared their notes with patients.

Making the physician notes available online really seemed to make a difference to patients.  At Geisinger, 82% of our patients viewed their notes. What’s more, patients reported feeling more in control of their care and being more likely to take their medications as prescribed when doctors shared their notes.

It’s rare for a single study in medicine to change practice so quickly, but the evidence about giving patients access to their notes is so compelling that most providers and departments at Geisinger have agreed to adopt OpenNotes as their new standard of care. Some departments are still tentative, willing to test this new openness with patients with just a few physicians.  We’re not expanding OpenNotes into psychiatry or pain medicine. And while pediatricians are participating, at this time we have excluded adolescents and young adults between ages 12-17 in order to safeguard their privacy.

We’re about two-thirds of the way there in terms of eligible providers willing to share their notes. However, the momentum is very strong and we will anticipate even greater participation over the next 12 months.  We are also actively working to bring in learners, and hope to make notes written by residents and fellows available to patients later this year. 

Expanding OpenNotes

We anticipate continued interest from patients and for OpenNotes to expand quickly to other Geisinger doctors; our goal is to get 80% of eligible doctors on board by July of 2014.

As we move ahead, we hope others will join us in adopting OpenNotes. It appears to be a safe yet effective way of engaging patients in their care. We believe that OpenNotes represents an important milestone in achieving transparency with our patients and, if we believe what our patients say, OpenNotes will become standard practice in health care across the country.

Jon Darer, MD, is chief innovation officer for the Division of Clinical Innovation at Geisinger Health System