Reading Your Doctor’s Notes Promotes Good Care

Medical record transparency is vital for patients who perceive themselves as partners in, not just recipients of, medical care. You have the right to review your medical file, and to have copies of it. Increasingly, practitioners understand that an informed patient is a better patient, and that care decisions should be mutual.

Patrick Malone’s book, “The Life You Save: Nine Steps to Finding the Best Care-and Avoiding the Worst,” advises patients always to read their own medical records to improve their understanding of the doctor’s advice, to spot errors or omissions and to maintain participation in their health care. OpenNotes is at the forefront of the patient participation movement. This initiative invites patients to review the notes clinicians make during patient visits.

A recent post on KevinMD.com illustrates how OpenNotes works on a large scale. The writer is Jon Darer, chief innovation officer of Geisinger Health System, a large health services organization that serves more than 2.6 million people in Pennsylvania. Darer says that more than 500 of Geisinger’s doctors have begun sharing their office visit notes with patients under the OpenNotes concept.

All Geisinger primary care doctors and general pediatricians, as well as some specialists in pediatrics, dermatology, endocrinology, pulmonology, nephrology, rheumatology, cardiology, cardiothoracic surgery, vascular surgery, neurosurgery and obstetrics/gynecology are participating in OpenNotes.

Unlike some practices, where patient requests to see information from their files often are treated as a bothersome request, Geisinger patients are encouraged to examine information. After their doctor visits, they receive an email inviting them to read their doctors’ notes via a secure online patient portal.

As Geisinger sees it, such access enhances adherence-the ability and willingness of patients to follow practitioner instructions and medication regimens-and reduces the chances for misunderstandings and errors. That saves everyone time, money and distress.

This enlightened approach was borne of research: Geisinger was one of three study sites that participated in a trial of OpenNotes, Darer says. The study was subsidized by the Robert Wood Johnson Foundation. Over 12 months, 24 primary care physicians from Geisinger, and 81 doctors from Beth Israel Deaconess Medical Center in Boston and Harborview Medical Center in Seattle shared their notes with patients.

Among Geisinger patients, more than 8 in 10 patients viewed their notes online. Darer writes that they reported feeling more in control of their care and more likely to take their medications as prescribed when doctors shared their notes.

As always, one study does not-should not-change the world. But this one was so compelling about the value of giving patients direct access to their notes that most providers and departments at Geisinger agreed to adopt OpenNotes as the new standard of care. “Some departments,” Darer makes clear, “are still tentative, willing to test this new openness with patients with just a few physicians. We’re not expanding OpenNotes into psychiatry or pain medicine. And while pediatricians are participating, at this time we have excluded adolescents and young adults between ages 12-17 in order to safeguard their privacy.”

Still, about 2 in 3 eligible providers expressed willingness to share their notes. Darer anticipates even greater participation in the next year. In addition, Geisinger intends to train medical students in the art of this patient participation; it hopes to make notes written by residents and fellows available to patients later this year. The organization’s goal is to have 8 in 10 of its eligible doctors participating in OpenNotes by mid-2014.

“As we move ahead, we hope others will join us in adopting OpenNotes,” Darer concludes. “It appears to be a safe yet effective way of engaging patients in their care. We believe that OpenNotes represents an important milestone in achieving transparency with our patients and, if we believe what our patients say, OpenNotes will become standard practice in health care across the country.”

If you don’t have a copy of your medical record, request one from your doctor. Read it thoroughly, and ask for updates every time you seek care. If you don’t understand something, ask for an explanation. If you see an error about your medical history, test results, diagnosis, medication or anything else, discuss it with your doctor and, if necessary, send a written clarification. As medical records become increasingly digitized and shared with a multitude of providers, facilities, insurers and billing agents, errors can be compounded and present significant risk. Remember: You’re in control of your information.

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