OTTAWA – An editorial in the Canadian Medical Association Journal is calling for physicians to provide patients with clear access to their health records when stored in electronic medical record systems.
Patients already have the right to see their medical records, including their doctors’ notes. But in actual practice, there are “hoops and speed bumps,” the editorial says, including lengthy delays (up to 90 days in some parts of the country) and access fees.
“Modern information technology and Internet capability offer the potential for useful transparency that has been shown to benefit patients and the healthcare system,” writes CMAJ deputy editor Dr. Kirsten Patrick (pictured).
In particular, patients are adept at spotting missing or incorrect information in the records. “A medical record with substantial gaps may result in a patient receiving suboptimal care, which is not in the best interest of either the patient or the physician,” writes Patrick.
What’s more, she said, “patients really like it.”
According to an article in PostMedia News, in the United States, more than three million Americans now have electronic access to their doctors’ notes through a national initiative known as OpenNotes.
The movement began with a one-year pilot study in 2010, when more than 100 doctors working at three large family medicine practices in three states agreed to invite more than 20,000 of their patients to read their notes securely online. Patients received emails when a doctor’s note was signed and posted to their portal.
The results were “striking,” according to the researchers: patients felt more in control of their care, had a better understanding of their medical issues and were more likely to take medications as prescribed. They were also able to share their notes with their caregivers.
At the end of the year, virtually all patients surveyed wanted “open notes” to continue and none of the doctors chose to opt out.
Few patients said reading the notes made them feel worried, confused or offended, as some doctors feared it would, said Jan Walker, an assistant professor of medicine at Harvard Medical School and co-founder of OpenNotes at Beth Israel Deaconess Medical Center.
Patients rarely requested doctors change their record and while many MDs worried they would have to spend more time “editing” or writing notes, knowing their patients might read them, or face a barrage of follow-up questions and emails from patients, most doctors reported little or no impact on their workloads.
Walker said opening doctors’ notes to patients could improve patient safety by allowing people to catch mistakes in their records.
In the U.K., the government has pledged to have open notes starting in 2015.
For patients, “What’s not to like?” said Patrick, of the CMAJ. “It’s your most valuable information – your health information – and people don’t like to be kept in the dark,” she said. Patients like transparency, she said. “They like to see what their doctors write about them.”
Some doctors worry that, if patients could read what they write about them, would they misinterpret?
Notes can be candid, describing a patient as “obese,” “anxious” or “malingering,” meaning willfully pretending to be sick when they aren’t.
“There’s this classic example where a patient got very upset because a doctor wrote in his notes ‘SOB’, which is shorthand for shortness of breath,” Patrick said. The patient took it an entirely different way.
“We need to be able to write notes in a way that can be understood” and patients need to be allowed to question what’s in their record if it’s inaccurate, she said.