Of the more than 1,600 healthcare providers who have shared their notes with patients over an extended period of time, most reported positive experiences, according to a study recently published in the Journal of the American Medical Association (JAMA) Network Open.
Of the 1,628 doctors, advanced practice nurses, registered nurses and others surveyed, most described positive experiences with this new effort to offer more transparent communication, although some reported spending increased time documenting clinical visits.
The researchers conducted a web-based survey of primary care physicians, specialist physicians, advanced practice nurses, physician assistants, therapists and others in outpatient settings at Beth Israel Deaconess Medical Center in Boston, University of Washington Medicine in Seattle and Geisinger Health in Pennsylvania. These were three of the original health systems involved in the OpenNotes movement, designed to encourage sharing notes between patients and doctors.
Invitations were sent to more than 6,000 clinicians, and about 27 percent participated in the survey. Participants were clinicians who had written at least one note that was opened by a patient in the year prior to the survey, which was administered from May through August 2018.
Of the survey respondents, 74 percent held positive views about note sharing. Thirty-seven percent of physician respondents reported spending more time in documentation, but most found the practice did not affect their workflow and would recommend it to colleagues at other institutions.
“Many studies find that patients report important benefits from reading clinical notes,” said Catherine M. DesRoches, Associate Professor of Medicine at Beth Israel Deaconess Medical Center and Harvard Medical School, and lead author of the study. “However, this practice is relatively new, and we wanted to understand the long-term impact on doctors and other clinicians. Our findings that most clinicians are positive about sharing notes should be reassuring to healthcare organizations as they work to offer greater transparency to their patients.”
What’s more, doctors with more years in practice and fewer hours spent in patient care were the most positive about open notes. Even among a subgroup of clinicians who were less enthusiastic, a majority endorsed the idea of sharing notes and believed the practice could be helpful for engaging patients more actively in their care.
Doctors reported changing the way they composed their notes, including both how they document sensitive information and guard against language that might be perceived as critical of patients. Female doctors were more likely than males to report making changes to their notes and spending more time in documentation, the study revealed.
Researchers believe that this study may help clinicians prepare for rapidly evolving changes in practice. The 21st Century Cures Act requires patients be given electronic access to virtually all the information in their electronic medical records. Final rules designed to implement the 21st Century Cures Act include a provision requiring that patients can electronically access all of their electronic health information at no cost, including the notes their clinicians write.
“We’ve learned over the past 10 years that truly transparent communication brings enormous clinical benefits to patients,” said Tom Delbanco, MD, the John F. Keane & Family Professor of Medicine at Beth Israel Deaconess Medical Center and Harvard Medical School, and co-founder of the international OpenNotes movement, and co-senior author of the study. “It helps them manage medications more effectively, and it builds trust and patient safety. We started small, but today 45 million patients in the U.S. have gained ready access to notes their doctors are writing.”
