Note sharing may be a tool to improve doctor-patient communication

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It’s been 20 years since patients were given the legal right to access medical notes, thanks to the Health Insurance Portability and Accountability Act (HIPAA), but wait times and processing fees often complicated the process.

Now, a pilot program that promotes easy, quick sharing of medical notes aims to improve patient engagement and education. The OpenNotes project involved 105 primary care physicians and 13,564 patients at three hospitals (Beth Israel Deaconess Medical Center in Boston, Geisinger Health System in Danville, Penn., and Harborview Medical Center in Seattle).

After a year of sharing notes, both patients and doctors supported the initiative. According to a recent report in JAMA, 99 percent of responding patients supported continued access to medical notes online, and more than 85 percent of physicians at the three locations agreed.

OpenNotes was developed by Tom Delbanco, MD, a professor of general medicine and primary care at Harvard Medical School, and Jan Walker, RN, an assistant professor of medicine at Harvard. Delbanco estimates about 100 healthcare institutions are at some stage, from planning to implementation, of sharing medical notes with patients.

Still, concerns remain about giving patients full access to medical notes. Information may be upsetting or misunderstood. Access can be limited by technology. Doctors, knowing such information will be seen, may censor themselves. The OpenNotes pilot program found 28 percent of participating physicians at Beth Israel, 9 percent at Geisinger and 11 percent at Harborview admitted to being less candid in their notes, knowing patients could read them.

“My notes are for me,” said Steven Malkin, MD, an internist. “If I knew a patient was going to read them, I would write them differently.”

Many physicians see the open sharing of notes as another way of communicating with patients.

“It is one more way they become part of decision making,” said Dawn Milliner, MD, Mayo Clinic’s chief medical information officer. “I view that as a very positive thing.”