How Nurses Can Empower Patients Through Shared Notes

Jan 4, 2013, 12:36 PM, Posted by

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

 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.

We tested OpenNotes over a year, recruiting 100 primary care doctors to share their visit notes with 13,500 patients. Visit notes were shared with patients via an online patient Internet portal at three health systems across the country: Beth Israel Deaconess Medical Center in Boston, Geisinger Health System in rural Pennsylvania, and Harborview Medical Center, a safety net hospital in Seattle.

What we found was astounding: Patients reported feeling more in control of their health and having a better understanding of their medical issues. They also said having access to their doctors' visit notes helped them remember their care plan more easily and that they were more likely to take their medications as prescribed.

Doctors involved in the study reported that sharing notes with patients had little impact on their workload -and many said OpenNotes helped strengthen their relationships with patients. Even though the study is officially over, no doctor has elected to stop sharing visit notes with their patients.

OpenNotes is a tremendous opportunity to get patients more engaged in their care. Everybody on the healthcare team should be doing this. Later this year (2013), Beth Israel Deaconess Medical Center will be expanding OpenNotes to nurses and other providers. Nurse practitioners will open up their notes to patients. So will clinical nurses who have consulting calls with patients and nurses who provide patient teaching about management of chronic conditions.

What's more, patients want this. In our study, we found that virtually all patients support the idea of seeing their entire medical record - including visit notes.

If we're serious about patient-centered care and transparency in medicine, then we need to make shared visit notes a standard of care for all of our patients.

Nurses have an important role to play in making this a reality. Not only can nurses advocate for OpenNotes in their institutions, they can educate patients about how to access and use their medical records to improve their care. Patients have a legal right to see their medical records, but most don't ask and doctors rarely offer them the opportunity.

Concrete steps include helping patients sign up to patient Internet portals - where they exist - to access information such as prescription lists and test results. Nurses can also encourage patients to ask their doctors and other clinicians for copies of their visit notes. With the transition to electronic health records, making patients' records readily available to them can be achieved with just a few clicks.

With medical records in hand, nurses can guide patients on how to use the information to better manage chronic conditions, such as asthma or diabetes, and make decisions about their healthcare. If patients spot errors in their medical records, nurses can help them get their records updated.

We've shown that OpenNotes can be incredibly valuable to patients and that it doesn't create a burden on providers. We know patients are overwhelmingly enthusiastic about access to their medical information. As more providers open up their notes to patients, we truly believe that we will see improvements in both health and healthcare.

We hope nurses will join us in spurring broader use and support for OpenNotes and we welcome your thoughts (in the comments section below) about how we can best use shared visit notes to empower patients to take a more active role in their health care.

OpenNotes is supported by the Robert Wood Johnson Foundation.



This commentary originally appeared on the RWJF Pioneering Ideas blog.