OpenNotes: The Results Are In

Oct 3, 2012, 6:00 PM, Posted by

Steve Downs Steve Downs

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.

105 primary care doctors, more than 19,000 patients and 12-months of testing at three sites has brought us to some striking findings: Patients overwhelmingly support open notes; they report significant benefits from it; and doctors reported that the effects on their practice have been minor. I encourage you to read the full paper so you get the full context (and do pay attention to the limitations section). You’ll find a number of interesting results. Here are three that I think are especially worth reflecting upon:

1. 60-78% of patients (depending on the study location) reported that they took their medications better.  This is self-reported data, so the numbers might be exaggerated, but this finding, along with other results related to taking better care of oneself and understanding one’s health conditions better, suggests there’s a significant potential for clinical benefit.

2. 86-89% of patients said that open notes would be an important factor in choosing a provider or a health plan.  If I were a provider, I’d pay attention to this result, which suggests that there might be good business reasons to adopt open notes.

3. 99% of patients wanted to continue with open notes.  Wow -- I’m not sure 99% needs much elaboration.

So we’ve found a simple intervention that:

  • appears to have clinical value;
  • doctors acknowledge is no big deal; and
  • patient support for it is so high that they’ll prefer providers who offer it.

It sounds like a winner. It sounds like a practice that should quickly become the norm.  It sounds like patients should demand it and that providers should figure out how to get ahead of that demand.

That’s my perspective at least, but I have to admit that while these results look pretty clear cut to me, I’m close to the project and no doubt I’m biased. I might be missing something. So help me out: Are there any good reasons why we shouldn’t try to spread this practice or has the time for open notes arrived?

This commentary originally appeared on the RWJF Pioneering Ideas blog.