Among the participating doctors, 74% to 92% thought it would lead to better communication and patient education. Only 45% to 67% of nonparticipating doctors thought it would. And, while 50% to 58% of participating doctors thought it would lead to more worry among patients, 88% to 92% of nonparticipating doctors thought it would.
Patient enthusiasm for the idea crossed age, education, and health status boundaries, the survey found.
So far, so good, Dr. Delbanco says. “No doctor I know has tried to kill me as a result,” he says.
Access to the notes means that patients don’t have to rely only on their memory, he points out. “Patients remember very little of what happened in the doctor’s office, and the best time to educate a patient is before a visit and after a visit,” he says. “And what better way than to be able to go home and at leisure open up your record, look it up?”
A movement towards more open notes might lead to an evolution of the notes themselves, Dr. Delbanco says. “It’s a very tall order for one note to serve all those different masters … the doctor’s memory, consultants, insurers, administrators, quality-of-care people—and now we’re adding the patient,” he says.
Overall, he says, open notes is like a “new medicine.” “It’s designed for the greater good of many people,” he says. “We suspect it’s a way to involve patients much more actively in their care, which is the main thing that moves us”—even though, for some patients, there may be contraindications.
What Other Research Has Found
A recent study done in the Netherlands—where, like in the United States, portal access is sometimes offered but is not widespread—set out to gauge rheumatology health professionals’ interest in, and concerns about, patients’ home access to their records.1
Researchers interviewed nine rheumatology nurses and nurse practitioners and 13 rheumatology physicians, stopping when they found they were getting no new valuable information.
The health professionals said they thought there would be advantages, such as enhancement of patient participation in their treatment, increased knowledge and self-management, and better interaction between providers and patients. But they also anticipated problems with patient interpretation, extra workload, a change in what is covered in consults, and even, potentially, a disrupted patient–provider interaction. The respondents also came to a consensus on preconditions: security must be optimal, there should a lag time in the release of lab results, and no access to clinical notes.
