Wednesday, October 17

Open Notes - Web Summary

Last week one of the most pivotal studies ever on opening up the clinical record to patients was discussed at a 2 hour long conference - here are some highlights from Dr Deblanco's remarks from Beth Israel.

Background:The project opened up the clinical record to the patient.

Process: After the patient saw the provider and the record was signed by the doctor the patient was sent a secure email simply alerting them that they could re
ad the visit note and then 2 weeks prior to their next visit they got a reminder suggesting that they review the notes..

Keep it simple, no educating, cajoling, just open it up for one year. (thanks to Steve Downs at RWJF)

 Slide 1  (time  on video 20:19)

19,000 Patients of whom 13,000 had a visit in the year of the study.
105 volunteer Primary Care Physicans

3 sites - Beth Israel, Geisenger and Harborview Medical Center (Seattle)

Slide 2 (21:22 on video)

3 core questions (no idea how to engage patients)

  1. Does OpenNotes help patients become more engaged in their care?
  2. Is OpenNotes the straw that breaks the doctors back?
  3. After 1 year, will patients and doctors want to continue?

Slide 3 Patients were Enthusiastic (22:15)

Patients used the notes 

  • Up to 92% of patients across all 3 sites read their doctors note(s). 
  • At Geisenger 87% read every single one of their notes.  
Patients reported important clinical benefits and benefits that patients value
  • Feeling more in control of their care (77% to 85%)
  • Better understanding of thealth and medical conditions (77% to 85%)
  • Doing better with taking their medications (60% to 78%) -
    (23:15) Tome Deblanco, MD Beth Israel Deaconess Medical Center "even if this was a five fold exageration and only a 15% increase in medication adherence we would apply for the Nobel Prize in Medicine"

Patients were rarely (1 - 8% ) confused, worried or offended by what they read in their doctors notes. 

(*this was the number one concern by 80% of doctors who didn't want to participate in the study)

Slide 4 Impact on Doctors - benefits with little disruption (24:40)

Many doctors reported strengthen relationships with their patients. (Felt safer with another set of eyes watching)

Some doctors change how they wrote notes

  • 0 - 21% reporting taking more time to write notes to be more educational
  • 3 - 36% reported changing the way they wrote about mental health, substance, abuse, cancer and obesity

Few doctors reported impacts on their workflow

  • Longer visits (0 - 5%) but some took less time so it was a wash
  • More time addressing patients questions outside of visits
  • Some doctors even wondered if anyone was reading them (when 9 in 10 did)

Slide 5 - New Medicine - Towards a new Standard of Care (26:15)

"We think of this as a new medicine.. I hope  will become a new standard of care".. "This medicine is designed to help the vast majority of patients and to help those that care for them as well.  I can't emphasize this enough - This isn't just a patient intervention -I think it will make the life of the doctor or the nurse or the caregivers richer as they get used to it."
  • Designed to help the vast majority of patients and those who care for them
  • Rarely contraindicated
  • Patients and providers will learn to use it widely and well 

27:25 Bottom Line (no slide)

  • 99% of patients wanted to continue with continue - never heard of 99% 
  • 85% said it would be important in choice of care giver.
  • Not one doctor stopped after a year - not all loved it but they all felt it was important to continue

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