Open medical notes gaining legitimacy

By Don Macgillivray

Have you ever wondered what’s in your own health records? Open-Notes (O-N) allows patients to read about their medical condition after a doctor’s appointment. The most effective way to do this is by email. Doctors and clinicians can provide patients with access to their notes electronically using a secure, password-protected e-mail message. If necessary the notes can be printed out and given to the patient or sent to them later by postal mail.

In a recent study, 86% of the doctors were satisfied using O-N and all were willing to use it in the future. Nearly all patients liked it and wanted to continue using it. A study published in the Annals of Internal Medicine stated that in a twelve month trial that 19,000 patients and 105 doctors gave O-N high marks.

Sharing notes does not change the clinicians’ longstanding pledge of confidentiality. As always, only clinicians involved in a patient’s care will have access to their notes. However, patients may choose to share their notes with caregivers, family members or others. Notes are confidential, and it is up to the patient whether they are shared with others.

Currently five million patients have access to their records through this system. O-N contains and reduces healthcare costs with a more efficient use of doctors time, the patient’s ability to improve their own care, and by helping to prevent medical errors.

At first doctors were slow to accept it, but they have found they are not a problem and that the notes have improved patient care. If the patient has questions or sees issues that need to be addressed, the doctor can respond to them to improve both their care and the doctor/patient relationship.

Sometimes the medical jargon is difficult for patients to understand. For example SOB is the medical acronym for “short of breath” which is not what many would assume it to be.

Portland has become a leader in the undertaking. It is in use by some of our countries major healthcare centers such as: Beth Israel Deaconess Medical Center in Boston, Geisinger Health System in Pennsylvania, Harborview Medical Center in Seattle, the Mayo Clinic Cancer Center, and the Cleveland Clinic. O-N is expected to be in use by all medical facilities within ten years. Perhaps this might be a step toward greater transparency in the management of healthcare financial records in the future.

In April of 2014 Kaiser Permanente Northwest became the first of their system to implement Open-Notes. They provide their nearly 500,000 members with online access to notes written by their clinicians. The notes are available following most primary and specialty care office visits or scheduled telephone visits. Members who are registered users of Kaiser’s website receive an email within 48 hours following their visit indicating that the notes of their appointment are available for viewing. Once they log on to “My Health Manager”, they see the office visit listed on the “Past Visit Information” tab in their record.

Oregon Health and Science University (OHSU) began offering O-N to selected patients and a small groups of physicians since May of 2014. O-N is available to more than 2000 physicians at OHSU sites and more than one million patients.

Providence Medical Group of Oregon provides care throughout the state for more than 115,000 patients from 620 medical clinicians. This year Providence leadership has decided to implement O-N as well as additional enhancements in their record system.

Portland Veterans Hospital has been using O-N for more than two years with great success. It is expected that this will soon be expanded to other veterans hospitals across the county. The doctors medical team handles the email replies and conveys the necessary information to a doctor as needed.

Federal Law gives patients the right to access to their medical notes to improve communication and understanding among patients and providers. Patients are more likely to understand their treatment, follow the doctors instructions, and take medications which allows them to actively engage in their treatment. Patients are better prepared for doctor visits and hospital treatments and discussions between patient and doctor are improved as well as healthcare outcomes. There is training for patients, doctors, and informal caregivers if needed through many of the participating facilities.

Patients have become ardent readers of their notes. With very little promotion of the program to patients, more than 40,000 individuals are viewing their medical records. The two most common requests from patients are for a correction of something recorded incorrectly or for a simple method of translating medical terminology within the record.

For more information about these systems see “Getting Started with Open-Notes.” It provides access to the toolkit with a step-by-step guide to using the system. It offers tips for patients and clinicians on maximizing the benefits with your health care provider. You will find in this toolkit a handout and a PowerPoint presentation, policy, and communication suggestions. Open-Notes is a not-for-profit initiative supported by philanthropic foundations and charitable trusts.

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Open medical notes gaining legitimacy

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