Increasing Transparency, Activating Patients: The Case for Open Medical Notes

Oct 11, 2012, 9:12 AM, Posted by Pioneer Blog Team

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.

Yet for many doctors, the idea of giving patients access to their medical notes is a bit nerve wracking.  There is an understandable fear that when patients see what doctors write about their visit, it could promote more uncertainty, more anxiety, and misinterpretations. But those fears didn’t materialize under the study; in fact, only a small percentage of patients, in the range of 1-8 percent, reported worry, confusion, or offense. This signals that patients probably are more worried or anxious by what they don’t see then what they do see. As doctors, we need to relinquish this paternalistic attitude toward our patients and engage them in their health care.

Now that we have the evidence of what this simple intervention can mean for both patients and doctors, it is time for more health systems to embrace this idea. We at Geisinger are committed to getting patients as actively involved as possible in either maintaining their health or being partners in dealing with whatever challenges they face. How can you really activate patients unless they are truly accessing the information that you have, and you’re truly convinced they understand what you’re trying to do and what you’re considering?

For Geisinger, which has had electronic health records for two decades, the OpenNotes project was a natural offering for patients who already were interacting with us electronically. But after a year of testing this out among a cadre of our doctors, we are committed to expanding OpenNotes systemwide. We see it as the next step in a journey towards patient activation. I hope the lessons shared at today’s OpenNotes forum spur other institutions to join us on this journey and make access to medical notes a standard of care.

This commentary originally appeared on the RWJF Pioneering Ideas blog.