My Health Counts! e-Patients

Learn More About the OpenNotes Study

Inviting patients to read their doctor’s notes, that simple idea is the centerpiece of a year-long trial that was tested in three health centers around the country: Beth Israel Deaconess Medical Center, a teaching hospital in Boston; Geisinger Health System, a rural set of clinics in Danville, PA; and Harborview Medical Center, a safety net hospital in Seattle.

The OpenNotes project set out to answer a basic, but revolutionary question: What happens when we give patients access to the notes their doctors write about them? The answer: Patients become more active partners in their health care. After 12 months of note-sharing, both doctors and patients reported on their experiences. Having easy access to their doctors’ notes helped patients feel more in control of their care. Patients also reported a better understanding of their medical issues, improved recall of their care plan, and being more likely to take their medications as prescribed.

This study involved interventions in the health care systems of Boston, Pennsylvania and Seattle, where primary care physicians in each site were invited to participate in offering OpenNotes to their patients.

With the intervention, patients were given access to their doctors’ notes for one year. Boston and Pennsylvania had preexisting patient internet portals, while Seattle used an experimental portal. Doctors who declined participation, and their patients, made up the comparison group. The authors used interviews and focus groups with doctors and patients to develop pre- and post-intervention surveys, and tracked uses of Internet portals before and during the intervention.

A total of 114 doctors participated in the intervention, along with 22,000 patients who were registered portal users. PCP participation rates varied across the three sites: 19 percent in Pennsylvania; 66 percent in Boston; and 87 percent in Seattle.

The heart of the OpenNotes project is to involve patients far more actively in all aspects of care and to improve communication between the doctor and the patient. It also encourages patients to share information with others, including those who care for them and it may help prevent mistakes.

Within days of seeing their doctors, patients received an e-mail inviting them to read the doctor’s signed note on a secure patient Web site. Two weeks before their return visit, patients received a second e-mail inviting them again to review their doctor’s note from the previous encounter.

After a year, almost all the patients were enthusiastic about the OpenNotes initiative.

Surprisingly, so were the majority of doctors. Approximately three-quarters of all the doctors said that such transparency had none of the dreaded impacts on their practice. Many felt there was more trust, better communication, more shared decision-making and increased patient satisfaction. While a portion of the doctors were hesitant at the beginning of the study, not a single one opted to stop sharing notes with patients after the study ended.

There were several surprising results for patients, as well. While many said they felt more in control of their own care, up to almost 80 percent of the patients said that reading their doctors’ notes helped them to take their medications more regularly and better follow their doctors’ treatment recommendations. Furthermore, having access to their doctors’ notes became so important that nearly all of the patients said any future decisions regarding doctors or hospitals would be predicated on being able to access their records easily.

The study was primarily funded by the Robert Wood Johnson Foundation’s Pioneer Portfolio, with additional funding from the Drane Family Fund and the Florence and Richard Koplow Foundation.

Additional informaton on the OpenNotes project on the web:

Visit the OpenNotes website

Read e-Patient Dave’s blog about the results of the OpenNotes project