UW Medicine outpatients to get access to doctors’ full notes

Study revealed abundant value of OpenNotes concept

By Brian Donohue  |  HSNewsBeat  |  Updated 11:45 AM, 09.02.2014

Posted in: Healthcare

  • (Click arrow for 3:14 video.) In a filmed interview, Dr. Shireesha Dhanireddy, a clinician at Harborview Medical Center, speaks with one of her patients about how their relationship changed during the OpenNotes test. Courtesy of Beth Israel Deaconness Medical Center
People become much more involved in their medical care when they can read their doctors’ full clinical notes as part of their online medical record. So says research accumulated over the past several years at three U.S. sites, one of them Harborview Medical Center. 
UW Medicine plans to go live with OpenNotes on Oct. 21.
Note saying UW Medicine seeks feedback from the UW community on the OpenNotes implementation.
That finding – and the realization among most participating doctors that their misgivings about the “OpenNotes” concept were for naught – is leading UW Medicine to make that same access available in late October to people who receive outpatient care at all of its clinics and hospitals.

“More than ever, our patients and their families are our partners in their care, asking great questions and wanting to understand the reasoning and tradeoffs that underlie a medical or surgical plan,” said Dr. Mika Sinanan, a surgeon and president of the UW Physicians practice group. “OpenNotes is one of the best ways to help make them part of the healthcare team.”
The OpenNotes study ran from 2009 to 2013, drawing on the experiences of more than 19,000 patients and 100 primary care physicians in Boston, rural Pennsylvania, and Seattle.
The findings were distinct: The great majority of patients who read their doctors' notes said they better understood their health and medical conditions and felt more in control of their care, said Dr. Joann Elmore, who was Harborview's section head of general internal medicine during the OpenNotes implementation and the study’s lead in Seattle. 
OpenNotes access made patients feel more in control of their care, said Dr. Joann Elmore.
picture of Dr. Joann Elmore
“The majority also said they thought they would do a better job taking their medications [with OpenNotes] and that they would understand why the doctor made changes to the medications,” she said.

As OpenNotes got underway, many physicians within and outside the study expressed concerns about making their notes available, even though the 1996 Health Insurance Portability and Accountability Act (HIPAA) gives patients the legal right to see their complete medical records.

Some physicians worried they would need to invest more time in writing the notes or that follow-ups with patients who had read the notes would take longer. They thought patients might take offense at the notes’ frankness. Some doctors expected to become less candid with their comments, knowing that patients would read them. 
"We've given up Latin (medical terms); why not make things easier still?" said Dr. Tom Payne.
picture of Dr. Tom Payne
As it played out, the physicians in the study “really experienced very little disruption. Less than 5% felt like it impacted their workflow and led to longer visits,” Elmore said. “A lot of doctors described feeling that OpenNotes strengthened the relationship with their patients.” 

Some physicians reported taking more time to write the notes and some changed the way they wrote about certain topics, Elmore said, “maybe for the better.”

Dr. Tom Payne, medical director of IT for UW Medicine and an internal medicine practitioner, gave an example of notes that might raise patients’ eyebrows.

“In medical parlance, we write ‘shortness of breath’ as SOB, which people are likely to misconstrue. ‘Chief complaint’ is the way we’re taught to characterize the main reason for an office visit, but a patient could see that and think, ‘My doctor thinks I’m a complainer.’ These are natural differences in our understandings, but it might be better if we used clearer language. We’ve given up Latin; why not make things clearer still?” Payne said. 

He and Dr. Jane Fellner will oversee the technical task of incorporating physicians’ notes into eCare, the secure online portal to UW Medicine’s electronic medical records. 
Clare McLean
Dr. Lisa Holland and a patient discuss his health at the UW Woodinville Neighborhood Clinic.
Dr. Lisa Holland and a patient discuss his health at the UW Woodinville Neighborhood Clinic.
A committee of physicians and administrators considered the breadth of the rollout. Despite their desire to tilt toward transparency and to remove longstanding boundaries of information, the panel decided viewing notes on a web portal is not appropriate for every patient’s circumstance.

“That level of openness might not serve people with life-threatening conditions where the diagnosis and treatment are evolving, or someone with a highly complex test result – say, for a genetic predisposition to life-threatening condition,” Payne explained.

“That situation is better interpreted with a conversation, in the absence of which the test result seems to confer a dire diagnosis or outcome. The person who sees that result without a contextual conversation may suffer unnecessarily.”
Tagged with: electronic medicine, Open Notes
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