Sharing the Medical Record
An intriguing project involves giving patients access to their doctor visit notes directly. Open Notes will demonstrate the feasibility and acceptability of allowing patients access to their electronic medical record posts in Massachusetts, Pennsylvania, and Washington. For now, more than 100 primary care physicians are participating. The perspective on this study, published in the current Annals of Internal Medicine, reviews a number of uses for the medical record as well as attitudes toward the pilot project.
Medical records evolved over the past century, from a mere description of the patient and his/her condition and treatment, to a legal document used to justify everything from the treatment to the level of billing. As noted in the article:
Doctors have long recorded patient encounters by generating records ranging from cryptic abbreviations on an index card to lyrical essays. Some follow Lawrence Weed’s exacting precepts for a problem-oriented medical record (1), and since the 1920s, few graduates of Columbia University College of Physicians and Surgeons forget the “Atchley History,” which commands that each patient leap off the page, instantly recognizable to anyone who reads the note (2).
More and more participants have access to patient records, yet access by the patient remains filtered, generally provided only with a specific request. Currently, patients legally have access to their medical records; all patients may view or request copies of their charts. Very few choose to do so. Open Notes will remove the “filter” between the patient and the record shown in the diagram.
So why do patients not already access their notes? Many feel they might be confused or learn distressing information. Most trust their doctors; however, many have welcomed participation in the Open Notes project, hoping it will provide improved understanding and insight into their condition and treatment. Both patients and physicians hope that errors in the record can be corrected quickly with this system. Physicians suggested other worries from their perspectives. These include greater time commitment to prepare a patient-friendly note, perhaps with less candor than might otherwise be expressed. Time to review notes with patients, both outside of and during clinic visits, may also be necessary. This consideration is not trivial for primary care physicians who already experience major time pressures. Patients also feared that their face time with a physician might suffer because of the requirement. Also, many physicians worry that patients may not understand technical terms or abbreviations (SOB=shortness of breath); poor grammar may embarrass some as well! Finally, concerns about negligence, malpractice, and other legal issues were raised.
The article summarizes interviews with physicians and patients participating in Open Notes (yes, it’s a qualitative research project, although it is not presented as a research study). They also provide a summary table of potential advantages and disadvantages of the project, noted by patients and participating physicians.
Of course, the ultimate outcome of the Open Notes project is not yet known:
Will patients and providers want to continue online access to notes when the year-long study ends?
Stay tuned for more. But in the meantime, how do you feel about giving patients free access to their notes? Let me know in the comments, please- oh, and make sure to tell me if you are speaking as a patient or a health care provider.