Q & A with Tom Delbanco and Jan Walker
You probably know that your doctors, nurses and other care providers write a note after an appointment or discussion, and that the note becomes part of your medical record.
Beth Israel Deaconess Medical Center is one of the first hospitals in the United States to invite patients to read their notes online. They are available through PatientSite, BIDMC’s secure, confidential website for patients.
We spoke with Tom Delbanco, MD, and Jan Walker, RN, MBA, leaders of the national OpenNotes initiative, to learn more about OpenNotes and how access to notes might benefit patients.
Q. Why is BIDMC offering OpenNotes?
We’ve long been interested in how patients view their care, and one thing that’s become clear to us over the years is that patients should have full and easy access to their records. We believe access will strengthen the partnerships between patients and their clinicians, and also enable patients to participate more actively in their care.
Q. Is there evidence that this can happen?
We believe the answer is yes. We invited 105 doctors and nearly 20,000 patients from BIDMC, Geisinger Health System in Danville, Penn., and Harborview Medical Center in Seattle to participate in a year of study. After each visit, the patients received an e-mail inviting them to read their doctor’s note. Four of five patients chose to read the notes, and more than one in five shared the note with a family member, partner, or someone else.
Those who read them said they understood their health and medical conditions far better, were better at taking their medications, and felt more in control of their own health care. At the end of the first year, 99 percent of the patients wanted the practice to continue, and each of their doctors chose also to continue the practice.
After reviewing these study results, the leadership of BIDMC decided to adopt open notes across the institution. And we’re excited that the idea of opening notes to patients is now catching on throughout the United States. Many institutions, including the Department of Veterans Affairs (VA), Mayo Clinic, and Cleveland Clinic, as well as Geisinger Health System and Harborview Medical Center — who were part of the study — have joined BIDMC in sharing notes, and we believe that open notes will soon become a standard part of everyone’s care.
Q. What kind of information can patients expect to find in the note?
Ideally, a note should summarize the most important material discussed during a visit. It should include information you provide, such as important family history or a description of your symptoms. It may also include blood pressure readings or other findings from a physical exam, lab results, medication details, the clinician’s assessment or diagnosis, the treatment plan, and what next steps are recommended or agreed upon, such as next appointments, additional tests, or referrals to a specialist.
Q. How can patients use the information in a note?
Patients often tell us it’s hard to remember everything discussed during a visit. Whether you’re healthy or ill, a visit is often stressful, and that doesn’t help you to remember all the information that’s shared in a short amount of time! In fact, studies show that up to 40 percent of what clinicians suggest in a visit may be forgotten.
With OpenNotes, you can easily review the information whenever you want. You can review treatment plans written by your physical therapist, confirm your memory about changes in medications written by your doctor, remind yourself to get a test ordered by your nurse, and refresh your memory about other information you discussed with your clinician. Looking back at your notes is also a good way to prepare for an upcoming visit, and can help you think about what you want to discuss.
Q. How can I read my notes?
To read your notes online, you need to join PatientSite, BIDMC’s secure and confidential website. If your clinician is on PatientSite, you can register at patientsite.org or ask anyone in your clinician’s office to help you. You will then have password-protected access to your medical information, including your notes. If you’re already on PatientSite, you’ll find notes written after August 12, 2013, under “About Me” in the records section.
If you don’t yet have a PatientSite account, or would like to read notes from visits or discussions before August 12, 2013, you can request your medical records from Health Information Management at BIDMC.
Q. Who at BIDMC is sharing notes?
The goal is to involve all BIDMC clinicians and offer OpenNotes to every patient who wants them. In August 2013, we started by providing access to notes throughout all of primary care, orthopedics and rehabilitation services. Since then, OpenNotes has been spreading to involve more and more clinicians and patients. This now includes notes written by surgeons, medical subspecialists, dermatologists and nutritionists, with other outpatient areas joining soon. Once you have a PatientSite account, you’ll get periodic messages when additional clinicians and units are added.
Q. Who can see my notes? Should I be worried about privacy?
Only you and the clinicians involved in your care can access your notes. The clinicians operate under the same strict patient confidentiality rules they always have. Outside of that relationship, you are in control of who sees your notes. You can maintain that level of confidentiality at home, or you may find real value in sharing your medical information with a loved one or someone involved in your health. That choice is up to you.
Q. What if there’s an error in the note?
Having accurate information in your health record helps ensure that you will receive the best care possible, so it’s important for the clinician who wrote the note to know if something needs to be corrected. You can call or e-mail the clinician’s office so that your medical record can be updated to reflect accurately all information you feel is important.
Above content provided by Beth Israel Deaconess Medical Center. For advice about your medical care, consult your doctor.
Posted January 2014
