Dr. Bruce McCarthy of Columbia St. Mary’s on Adopting OpenNotes

Nov 4, 2013, 8:00 AM, Posted by Pioneer Blog Team

On Nov. 1, Columbia St. Mary’s Health System in Milwaukee became the first hospital in Wisconsin to implement OpenNotes. Beginning this month, some 1,100 multi-specialty doctors, nurse practitioners, and others who write visit notes will be sharing them with more than 300,000 patients via a secure online portal. Columbia St. Mary’s is part of Ascension Health, the largest nonprofit Catholic health system in the country. This month, it also becomes the first hospital system to share hospital discharge summaries with patients. Bruce McCarthy, MD, President, Physician Division, an internist who oversees the system’s medical group, spearheaded the rollout of OpenNotes here. An innovator who "puts patients first," Dr. McCarthy talked to Pioneer about why it’s time to make the idea of sharing medical notes a routine practice.

Why are you bringing OpenNotes to Columbia St. Mary’s?

Ten years ago, a colleague at Henry Ford Health System in Michigan raised this idea of sharing visit notes and I called it "crazy." But I became a lot more intrigued as my own mom aged and started to develop signs of dementia. She would go to her doctor and when I asked about the visit she would always say "the doctor says everything is fine" when I knew that wasn’t the case. Because I knew her doctor, I had a special connection. But not everyone has those kinds of ties. I believe everyone should have a connection to what their parent’s doctors are saying. If we could read the notes of our elderly parent’s doctor, it would really help us stay on top of their care.

What was the reaction to this idea?

About six months after I arrived here, I gave a presentation where I showed a slide showing someone holding a poster saying “Give Us Our Damn Data.” The message I delivered to the group was pretty simple: doctors have always had the power in the relationships with their patient but that paradigm is shifting. We now work for the patient and their medical record is theirs. There were a lot of polite nods. They probably saw me as the new guy coming in with a far-fetched idea. Many doctors thought it would never happen.

How then did you convince them?

I liken it to academic detailing. I started giving talks to different specialty groups, participated in Grand Rounds, presented slides from the national OpenNotes study, and developed a coalition of champion leaders. For us, the strategy was about assembling evidence, making clear and convincing arguments, taking the moral high ground about the merits of this, and connecting on a personal level to someone’s parent or relative. I also showed how this was going to help patients better remember their visit with their doctor. Having evidence from the OpenNotes study was key. For some doctors, it was all about the results and the impact. For others, it was a fait accompli. They accepted that this was coming and they might as well embrace it. They realized that the hospital won’t gain anything in terms of market advantage by waiting.

How long did it take?

We talked for two years but a few months ago we decided to roll it out for this year’s open enrollment on November 1. Some wanted to delay but others felt like moving ahead would help doctors write better notes. One group voted against this but the majority of doctors wanted this to move forward. It’s important for dissenters to be heard, but in the end, we decided it was important to act as one group and all physicians participated.

Do you think patients will embrace this?

A lot of patients already have said they are excited about this. It is really interesting how it’s playing out. One doctor who initially opposed the idea and thought his patients wouldn’t even want it, decided to print out his office visit notes for patients to see if his theory would hold. He sent us a long e-mail after his experiment; he admitted he thought open notes were not worth it but he recognized that his patients thought differently. They gave him an overwhelmingly positive response when he shared his notes. He became a convert and we circulated the testimonial email to other doctors.

Was the OpenNotes study important to your case?

It helped a lot. This tipped the balance. Having Dr. Tom Delbanco talk to our leadership about his experience provided comfort that the world wouldn’t end if we went down this path.

OpenNotes continues to expand, and now gives more than 1 million patients and families access to their doctor’s visit notes. Funded in part through a $1.4 million grant from the Robert Wood Johnson Foundation’s Pioneer Portfolio, the 12-month OpenNotes project brought together 105 primary care doctors and more than 19,000 of their patients to evaluate the impact on both patients and physicians of sharing doctors’ notes aftereach patient encounter.

This commentary originally appeared on the RWJF Pioneering Ideas blog.