Reading Visit Notes Improves Patient Healthcare Experience

Diana Swift

February 25, 2016

Primary care patients who read their physicians' visit notes online are more informed and satisfied users of healthcare, according to findings published online January 29 in BMJ Open.

"Patients in this evaluation suggest that reading notes helped improve their understanding of health information, fostered better relationships with doctors, improved the processes of care, and helped with self-care," write Tobias Esch, MD, from the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, and coauthors. "They are also interested in becoming involved more actively in the generation of their medical records."

The study, which surveyed and interviewed primary care patients at Beth Israel Deaconess, was part of the OpenNotes project, a growing national initiative to make transparent electronic medical records the standard of care.

Although US patients have had the right to their medical records since the passage of the Health Insurance Portability and Accountability Act in 1996, access can be difficult and costly. Results from primary care practices at three medical institutions published in 2012 suggested that patients access notes frequently, report benefits, and want the practice to continue.

The current study analyzed 576 free-text answers from patients answering surveys, 414 of whom were women and 162 were men, aged 23 to 88 years. An additional 13 frequent-user patients (at least eight notes read in 24 months) were interviewed face to face (nine women and four men, aged 58 to 87 years).

Frequent note readers reported positive experiences and greater engagement in their care. Patients appear to evaluate the healthcare experience across five domains: understanding, relationships, quality, self-care, and future hopes. The most common theme in respondents' texts was understanding, with patients reporting that physicians' notes were useful for refreshing memory and improving understanding of health information.

Respondents also said the notes increased trust, allowed better management of their medications, helped them avoid harm, and gave them a stronger sense of control. "I think it's important to know that I'm trusted as part of this relationship. And it helps me trust the doctor as well," commented one respondent.

A majority of patients said they did not share their notes with others.

Nearly all the interviewed patients reported that access to their notes allowed them to amend their therapeutic regimen, correcting wrong medication dosages or dosing schedules, for example. As one patient writes, "I was [online] and happened to see that I was taking the wrong amount of prescription."

The general hope was that ready access to physicians' notes would become the norm. "I do think that transparency is key and is quality of care," one respondent wrote. "I think it's important for patients to understand truthfully what their situation is and how they can help themselves and be educated enough to be able to ask the right questions to physicians."

Almost all respondents reported occasional errors in the notes, and some admitted they had withheld information out of privacy concerns, especially when mental health was an issue. Others wanted an embargo on notes with delayed access, enabling their physicians to convey bad news in person.

Other respondents favored interactive input so they could amend or comment on notes, but this technology is not yet available. "We will need to develop these capabilities to be responsive to engaged and activated patients," the authors write.

The authors acknowledge their conclusions were possibly biased and limited in generalizability, as study patients constituted a select group from a single health system who registered on secure electronic portals.

Noting that the Institute of Medicine recently advocated the adoption of open notes, the authors call for more research into the risks and challenges involved. "As the use of fully open and transparent medical records spreads, it is important to gain a deeper understanding of the possible benefits or harms, and to characterise target populations that may require varying modes of delivery," Dr Esch and colleagues write.

This study was supported by grants through the Commonwealth Fund. Support for the overall OpenNotes project was provided primarily by the Robert Wood Johnson Foundation. The authors have disclosed no relevant financial relationships.

BMJ Open. Published online January 29, 2016. Full text

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