Giving patients access to doctors' notes in electronic health records can increase engagement, safety and care quality, according to a study published in the Joint Commission Journal on Quality and Patient Safety, FierceHealthIT reports (Hall, FierceHealthIT, 8/13).

Background on OpenNotes

A pilot project to test OpenNotes was launched in 2010 and funded through a $1.4 million grant from the Robert Wood Johnson Foundation Pioneer Portfolio. It involved about 100 primary care physicians and 25,000 patients at:

• Beth Israel Deaconess Medical Center in Massachusetts;
• Geisinger Health System in Pennsylvania; and
• Harborview Medical Center in Washington state.

At the end of the pilot program, 99% of participants said they wanted continued access to physician notes, regardless of initial privacy concerns (iHealthBeat, 4/10/14).

Department of Veterans Affairs hospitals began to offer OpenNotes in 2013, and nine health organizations in Oregon and Washington used the tool beginning last year (FierceHealthIT, 8/13). Since its launch, the initiative has grown to reach 5 million users nationwide (BIDMC release, 8/13)

Study Findings

For the study, researchers affiliated with BIDMC analyzed five years' of survey data on the use of OpenNotes to determine issues related to patient safety and quality of care (FierceHealthIT, 8/13).

According to the study, patients said having access to their doctors' notes helped them to:

• Notice errors in their records;
• Recall more of what happened during office visits;
• Remember to follow up on important appointments; and
• Remember to take their medication.

Meanwhile, doctors said the OpenNotes system had little to no effect on their workflow.

However, doctors expressed some concerns, including:

• How patients would define mistakes;
• How patients would report errors (BIDMC release, 8/13);
• How the process would affect patient-provider trust; and 
• Whether their notes would become vague knowing that patients would be reading them (FierceHealthIT, 8/13).

Overall, lead author Sigall Bell -- an assistant professor at Harvard Medical School -- said patients and doctors said OpenNotes helped them:

• Improve coordination of care;
• Improve error reporting;
• Improve plan adherence;
• Reduce diagnostic delay;
• Remember next steps; and
• Spot medication errors.

Next Steps

The researchers are using the preliminary findings to guide a two-year study called the OpenNotes Patient Safety Initiative. The study, funded by hospital insurance provider CRICO, will look at how sharing doctors' notes with patients affects:

• Communication;
• Medical errors; and
• Patient safety.

Researchers also have implemented a pilot program using an OpenNotes prototype with a group of volunteer clinicians at HealthCare Associates, BIDMC's primary care practice. Recently, CRICO provided funding for more widespread access to OpenNotes at BIDMC and Boston Children's Hospital (BIDMC release, 8/13).