“It’s transparency, get over it!” C.T. Lin, M.D. told his audience at the Ritz-Carlton Denver on Tuesday morning, July 12. Dr. Lin, the CMIO of UCHealth (formerly the University of Colorado Health System), shared his organization’s experience with the OpenNotes phenomenon, and challenged attendees at the Health IT Summit in Denver, sponsored by the Institute for Health Technology Transformation (iHT2—a sister organization to Healthcare Informatics under the Vendome Group corporate umbrella), to consider how profoundly the flowering of the Internet and social media is impacting healthcare consumers these days.
Dr. Lin shared the experience that he and his colleagues at the Denver-based UCHealth, an organization that encompasses six inpatient hospitals, 17 emergency departments, and 350 clinics, have been having with OpenNotes, in which patients are given direct access to their physicians’ notes, as well as with what they are calling “Open Results”—an element of the OpenNotes movement that is often implemented early on, in which patients are given immediate or near-immediate access to their laboratory test and other diagnostic test results. UCHealth went live with Open Results in 2008, and since then, 3 million results have been viewed by patients, with no negative impact.
And in May of this year, UCHealth went live with Open Notes, and, contrary to the fears of some physicians, everything went extremely well, with benefits in the form of increased patient satisfaction, enhanced patient perceptions of outpatient care, and increased patients’ trust in their physicians.
Lin spent some of his time unpacking and “busting” some of the myths around OpenNotes and around transparency of data and information in healthcare. Among them: that the implementation of OpenNotes would lead to a deluge of patient messages and phone calls to their primary care and other physicians; that the releasing of test results to patients would lead to all sorts of problems, such as patient confusion and alarm, physician distress, etc.; that patients would comb through their physicians’ notes to try to find errors and problems; that the implementation of OpenNotes would lead to massive over-utilization of clinic visits and other utilization.
In fact, of course, none of those dire predictions came to pass. Instead, the UCHealth leaders saw happen what has happened at every organization that has implemented OpenNotes. Patients’ communications with their doctors and doctors’ staffs did not increase by volume; patients did not overwhelm their doctors, or anyone else, with probing questions about what was in their doctors’ notes; and there was no perceptible increase at all in patient utilization of care services.
Very importantly, Dr. Lin noted, the world is changing quickly. He showed a slide depicting the historical understanding of physicians of their place in the healthcare system—as being at the center of all access to services, further referrals, and importantly, all information and knowledge. With the Internet and widely disseminated general health knowledge, and with social media, he noted, the world that patients/healthcare consumers inhabit is in complete contrast with the old, physician-centered world. Patients/consumers, he emphasized, are bringing information, data, and intellectual challenge and stimulation, to their physicians and other healthcare providers—and the world is never going to go backwards again to being a physician-centric or provider-centric universe.
Meanwhile, among the many positive consequences of the implementation of OpenNotes at UCHealth have been the following:
> A 24-percent improvement in patient satisfaction with their medical care, once they could message their physicians
> A 19-percent improvement in patients’ perception of the quality of the medical care they received in clinic, once OpenNotes was implemented
> A 24-percent improvement in patient satisfaction with regard to patients’ ability to do automated scheduling online
“Patients are more satisfied with the communication they share with their doctors, and overall, with their care now,” Lin told his audience. What’s more, “Physicians are neutral to positive about it all,” even those physicians still practicing in the fee-for-service world.” And the messaging volume has been very modest, averaging 1 message per every 250 patients.
Fundamentally, the world is changing very quickly, Lin emphasized, and OpenNotes is one element in broader change sweeping U.S. healthcare. “Information transparency is our future,” he concluded. “And Facebook will change healthcare.” What’s more, he said, it is important for healthcare leaders to understand that “online patients are healthcare’s greatest untapped resource,” as they will bring engagement, knowledge, and stimulation to their relationships with their physicians. “And,” he said, “in IT, it really will be OK. And after that, it’s all up to us.”
And then, he delighted his audience with a brief performance of a song he composed about patient records management, accompanying himself on his ukulele.