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    Patient record transparency and the impact on physicians

    Many physicians are not comfortable sharing their progress notes with patients, concerned that they will take offense, be confused and add to the practice workload by calling or emailing with questions.  

    But under the Health Insurance Portability and Accountability Act (HIPAA), physicians must share their notes with patients who ask. Some physicians have embraced this sharing, encouraged by a nonprofit
    Boston-based initiative called OpenNotes. Their experience can serve as a guide to others who want to navigate this challenge.

    A note is a much richer source of information for the patient than lab results or an algorithm-driven clinical summary, says Janice Walker, RN, MBA, a principal investigator at OpenNotes and a researcher at
    Boston’s Beth Israel Deaconess Medical Center. "Your labs are a series of data points, but notes, especially if you [the patient] have a chronic condition and if you read the notes over time, tell the story of how you're doing."  

    The OpenNotes team of investigators, physicians and medical informatics experts works to make note sharing the norm rather than the exception. Through research and guidance, OpenNotes encourages hospitals and physician practices with electronic health record (EHR) systems to push notes onto the patient portal and automatically notify patients when the note is available.

    Sharing notes the 'next step'

    OpenNotes began in 2010 with a two-year pilot study among 105 primary care physicians at three institutions—Beth Israel Deaconess Medical Center in Boston; Pennsylvania-based Geisinger Health System; and Harborview Medical Center in Seattle—involving 19,000 patients. Today, more than six million patients have access to clinicians’ notes at 25 healthcare systems across the country through the initiative.

    And with the U.S. Department of Health and Human Services (HHS) urging more transparency regarding patient records (see page 2), that number could grow. 

    University of Missouri Health Care in Columbia began sharing notes with patients for outpatient visits in January 2015. "In the last three years, we’ve been working on engaging our patients in their own healthcare, and you can't be engaged if you’re not informed," says
    Thomas Selva, MD, a pediatrician and the system’s chief medical information officer. Sharing notes was the "natural next step."

    The system's physicians were hesitant at first, concerned about changing how they write notes so patients understand  them and about the time required for more detailed notes. Selva says none of these concerns came to pass.


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