OpenNotes: A New Opportunity to Communicate with Patients

OpenNotes enables care providers to use their notes as a tool to help patients understand their care and gain cooperation. The thinking is that, for patients to be able to engage in their health care, they need access to their medical information. Offering access to clinicians’ notes opens a pathway of communication between the patient and the care provider so both can better understand what is required to help the patient.

Experts who support this initiative believe that OpenNotes can potentially help patients better manage chronic conditions and prevent medical errors. The resulting improvement in communication and adherence to the medication and treatment plan can ultimately reduce health care costs.

In a year-long trial of OpenNotes, more than 100 primary care physicians at three health centers invited 19,000 patients to read their visit notes online. At the end of the trial, the study reported that patients who had accessed care provider notes felt more in control of their health care, better understood their medical issues, and believed they would be more likely to take medications as prescribed. Almost all of the study’s participants agreed with the OpenNotes concept. All of the physicians in the study continued to share notes with their patients after the study ended. Many believed they had strengthened relationships with their patients. At the conclusion of the study, all three study sites decided not only to continue, but to expand their OpenNotes initiative.

The Nurse’s Role

As patient advocates and educators, nurses can play a key role in OpenNotes by promoting the sharing of nurses notes as a standard of practice. Patients who have shared such notes report being better able to remember the information they’ve discussed.  (According to experts, as much as 80% of medical information provided to patients by healthcare practitioners is forgotten immediately.) Patients can also share their notes with their caregivers, thus improving the probability that the recommended treatment plan will be followed. Sharing nurses notes with family members and other caregivers also improves communication during handoffs from one care setting to another.

Some questions need to be addressed about how OpenNotes can be operationalized in specific cases (for example, patients with mental health issues) and in some health care settings, such as patient-centered medical homes. Clearly, the OpenNotes initiative is beginning to take hold. The Veterans Health Administration, Mayo Clinic, MD Anderson Cancer Center, Group Health and Cleveland Clinic are now sharing or planning to share physician notes with patients. More than 500 physicians at Geisinger Health System are now sharing notes with their patients. Beth Israel Deaconess Medical Center is expanding its OpenNotes effort to include nurses and other clinicians. Plans to adopt this initiative are in progress at other health systems across the country as well.

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