Geisinger to provide patients access to physicians' notes
What happens when physicians share notes with their patients?
Oct. 8, 2009, DANVILLE – Patients across the country are voicing a growing interest in becoming more involved – and having more control – over their own medical care. A new study, in which Geisinger is a participant, will examine the impact of adding a new layer of openness to a traditionally one-sided element of the doctor-patient relationship – the notes from patients’ doctors’ visits.
Funded through a $1.4 million grant from the Robert Wood Johnson Foundation (RWJF) Pioneer Portfolio, the 12-month OpenNotes© Project will bring together approximately 100 primary care doctors and 25,000 patients to evaluate the impact on both patients and physicians of sharing the comments and observations made by physicians after each patient encounter. Led by Boston’s Beth Israel Deaconess Medical Center (BIDMC), the study will include primary care physicians and patients at Geisinger and at Harborview Medical Center in Seattle.
“Doctors have strong differences of opinion about this, but there is almost a religious character to the debate – it’s uniformed by evidence,” said Stephen Downs, an assistant vice president at RWJF and member of the foundation’s Pioneer Portfolio, which supports innovative ideas and projects that may lead to important breakthroughs in health and health care. “It’s a subtle change – but it could reposition notes to be for the patient instead of about the patient, which might have a powerful impact on the doctor-patient relationship and, in the long run, lead to better care.”
Researchers hope to learn whether the increased transparency will increase patient-physician trust and communication, and better engage patients in managing their own care.
That premise is based in part on a recent study by Tom Delbanco, M.D., a primary care physician at BIDMC and the Richard and Florence Koplow-James Tullis professor of General Medicine and Primary Care at Harvard Medical School, and Jan Walker, R.N., MBA, instructor in Medicine in the Division of General Medicine and Primary Care at BIDMC and Harvard Medical School. Reporting in the Journal of General Internal Medicine (JGIM), Delbanco and Walker found that consumers want full access to all of their medical records and are willing to make some privacy concessions in the interest of making their medical records completely transparent.
By early next year, the Geisinger team hopes to provide several thousand patients who utilize the MyGeisinger Web portal with online access to their primary care doctors’ notes. Patients will receive reminder e-mails that the notes are accessible. By contrasting the experience of trial participants with unenrolled physicians and patients, the researchers hope to measure the impact access to the notes has on patients’ engagement in their care.
According to Jonathan Darer, M.D., Geisinger's lead investigator on the project, patients generally retain only a portion of the information that is exchanged with their doctor. He believes that access to doctor’s notes will reinforce information provided at the time of the doctor’s visit. But, he said, doctors are split on the value of open access to their notes in patients' records.
"While some doctors have been quick to sign up because they are interested in the potential benefit and see it as a step into the future, others are more pragmatic - worried that the notes could be misinterpreted and create more communication issues than they solve," explained Dr. Darer.
“Many doctors use the notes to remind them about important details in their patient’s life as well as to provide a clinical update,” he said. “Doctors also keep the notes because insurers require them.”
"For example, I might write that my patient has gained 25 pounds and I spoke to the patient about the increased risk of diabetes and heart disease with age and weight gain," he said. "It's possible that the patient may not have heard that message in my office but when reviewing the notes at home, the patient may be better able to absorb and positively react to it."
Of course, patients have a legal right to obtain their paper records, which usually includes notes, but they often have to wait to get copies and must pay a fee. Online access would be quick, easy and free.
According to Dr. Darer, the ultimate measure of the pilot's success will be whether doctors and patients want to keep sharing notes at the end of the study.
Patients who have doctors participating in the project will be notified in late fall about the enhanced MyGeisinger feature.
About Geisinger Health System
Founded in 1915, Geisinger Health System (Danville, PA) is one of the nation’s largest integrated health services organizations. Serving more than 2.6 million residents throughout central and northeastern Pennsylvania, the physician-led organization is at the forefront of the country's rapidly emerging electronic health records movement. Geisinger is comprised of two medical center campuses, three hospitals, an 800-member group practice, a not-for-profit health insurance company and the Henry Hood Center for Health Research—dedicated to creating innovative new models for patient care, satisfaction and clinical outcomes. For more information, visit www.geisinger.org.
About Beth Israel Deaconess Medical Center
Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School, and consistently ranks among the top four in National Institutes of Health funding among independent hospitals nationwide. BIDMC is clinically affiliated with the Joslin Diabetes Center and is a research partner of Dana-Farber/Harvard Cancer Center. BIDMC is the official hospital of the Boston Red Sox. For more information, visit www.bidmc.org.
About the Robert Wood Johnson Foundation and the Pioneer Portfolio
The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. The Foundation's Pioneer Portfolio is dedicated to accelerating the trajectory of innovative ideas that may lead to breakthrough improvements in the future of health and health care. Projects in the Pioneer Portfolio are future-oriented and look beyond conventional thinking to explore solutions at the cutting edge of health and health care. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. Visit www.rwjf.org/pioneer.