Inviting patients to read
their doctors’ notes: A quasi-experimental study and look ahead

T., Walker J., Bell S., Darer J., Elmore J., Farag N., Feldman H., Mejila R.,
Ngo L., Ralston J., Ross S., Trivedi N., Vodicka E., Leveile S. Annals of
Internal Medicine. 2012; 157:461-470.

medical records provide a secure and efficient way of handling patients’
records. In addition, electronic medical records easily allow doctors to
provide patients access to their notes. However, there is little information regarding
the experiences of doctors and patients when patients are invited to read their
doctor’s notes. Therefore, the objective of this study was to evaluate the
effect on doctors and patients of providing access to doctor’s notes when using
a secure internet website. First, primary care physicians and patients completed an online survey about their expectations before initiation of the OpenNotes (the online secure
source for doctor’s notes) intervention. Then, 105 out of 113 primary care
physicians (affiliated with 2 urban hospitals and 1 rural set of medical
practices) wrote at least 1 note using OpenNotes during a 12 to 19 month
period. Furthermore, 13,564 out of 22,703 of their patients used OpenNotes for
12 to 19 months and had at least 1 note in the system. OpenNotes automatically
emailed the patients once a note was finished. After that, 41% of patients and
94% of primary care physicians answered a post-intervention survey to help the
researchers compare between pre-intervention expectations and actual
experiences. Among the patients with notes available 84% at site 1, 92% at site
2, and 47% at site 3 opened at least 1 note. The most common reason for not
reading the notes were “I forgot they were available” (33%),  “I could not find the notes online” (23%), or
had “no reason” (17%). Among the patients that read the notes 19% reported to
their doctors that they read the notes. The majority of patients reported that
they perceived benefits of having access to their doctor’s notes (e.g., taking
better care of themselves, feeling better prepared for their visits, understanding
their condition better, feeling more in control of their condition, adhering to
their medication better). In contrast, very few patients had negative
experiences (e.g., feeling more confused or offended about the notes; <10%).
The most common concern expressed by patients was regarding privacy (26% to 36%
of patients). After the intervention, very few primary care physicians reported
a change in the volume of e-mails from their patients, duration of visits (<
5%), or time outside the visit spent addressing patients’ questions (0% to 8%).
Three to 36 percent of the primary care physicians reported changing the
documentation content and < 21% reported taking longer to write their
notes. When asked “what was the best thing about opening your notes to patients
online?” 70% of doctors responded about strengthening the patient-doctor
relationship. None of the doctors opted to discontinue using OpenNotes after
the study.

patients to view electronic notes seems to have many benefits while imposing little
impact on the workload of clinicians. Interestingly, the patients reported better
adherence to their medications, which may be due to having it written down as a
reminder. In sports medicine, we could provide patients access to their
documentation, which may influence adherence. For example, they could read about
their physical therapy program, progress to date, or how long to apply ice or heat.  Another important finding was that patients
and doctors believe that sharing the notes strengthened their relationship.
This could lead to better communication and improved care, which may improve
our evaluations and make it easier for our patients to ask questions or
approach us with tough issues. One major limitation of the current study was that
it might not be generalizable to all U.S. practices since only 3 sites were
used in the study. Regardless, providing patients access to their doctors’
notes may be a low cost way of achieving medical benefits. What disadvantages
or other benefits do you believe would come about from doctors sharing their
notes? Do you think patients participating in rehabilitation would adhere more
to their rehab program if they could see their notes and progress?

by: Jane McDevitt MS, ATC, CSCS
by: Jeffrey Driban

Delbanco T, Walker J, Bell SK, Darer JD, Elmore JG, Farag N, Feldman HJ, Mejilla R, Ngo L, Ralston JD, Ross SE, Trivedi N, Vodicka E, & Leveille SG (2012). Inviting Patients to Read Their Doctors’ Notes: A Quasi-experimental Study and a Look Ahead. Annals of Internal Medicine, 157 (7), 461-70 PMID: 23027317