Electronic Health Records

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Open EHR notes pilot expands after positive patient response

By Jennifer Bresnick

After a pilot program that offered thousands of patients access to their EHR notes exceeded expectations in patient and physician satisfaction, Beth Israel Deaconess Medical Center in New York and Geisinger Health System of Pennsylvania are widening the net.   More than 13,000 patients were allowed to view their entire EHR file using an online portal and electronic messaging, and nearly 12,000 of them viewed at least one note.  With a full 80% saying that open access made them feel more in control of their care, and 70% saying that they increased their medication adherence after reading what their physicians wrote about them, Beth Israel Deaconess will be rolling out access to its 50,000 patients who are already registered online.  Geisinger will be adding more than five hundred physicians to the program, as well.

The pilot showed that patient engagement is as easy as letting patients in.  While there was some concern that patients would be confused, overwhelmed, or offended by what their primary care physicians wrote about them, only 1% to 8% of patients among the three sites felt worried after reading their clinical information.  Sixty percent wanted to take open access one step further and edit their own notes.  Ninety-nine percent of participants wanted access to continue after the pilot was finished, and none of the physicians opted out, even when given the chance to do so.

Now they’re getting their wish.  “[Patients] said they took better care of themselves, they better remembered their plan of care, they felt more in control, and about two-thirds of the patients taking medications said they were taking their medications better,” notes Jan Walker, RN, MBA, co-principal investigator of the pilot.  “I’ve never done a survey before where 99% of people said anything.”

Provisions will be made for children and psychiatric cases, the institutions have said.  Physicians will be able to exclude patients from open access if they suspect drug seeking behavior or feel reading the note may do much more harm than good.  Geisinger will exclude adolescent patients between 12 and 17 to give them a safe space to interact with their physicians, says Jonathan Darer, MD, chief innovation officer of the health system.  “Nobody’s comfortable at this point lighting those notes up,” he says.  “We don’t want the notion that the parent might be able to see the note to inhibit the kid from asking whatever it is they want.”

Patient engagement will become even more pressing as Stage 2 of meaningful use comes into play, requiring at least 5% of patients to access information through an online portal and communicate with their physicians.  If the results produced at Geisinger and Beth Israel Deaconess are representative of just how much patients want to participate in their own care, that number should be easy to reach. “The open notes study showed something we physicians are reluctant to accept: our patients think for themselves and want to participate in their own care,” adds Dr. Rob Lamberts. “Yes, there could be hacking, and there will be some people who want nothing to do with this responsibility. Patients should have access to their records because they are their records. We do a huge amount of harm to people by ‘protecting’ them from the information in their own charts.”

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