Patients Want Electronic Link To Doctor's Notes

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While the federal government's EHR incentive program requires physicians to provide visit notes to patients who request them, little is known about how doctors and patients view this kind of information sharing or what effect it has on patient care. A new study by Harvard researchers takes a step toward filling that knowledge gap, suggesting that patients are far more enthusiastic about the potential benefits of viewing their visit notes online than physicians are.

The study, published this week in the Annals of Internal Medicine, presents the results from surveys of physicians and patients in three healthcare systems: Beth Israel Deaconess Medical Center in Boston, Geisinger Health System in Pennsylvania, and Harborview Medical Center in Seattle. The researchers conducted the surveys prior to the commencement of a yearlong trial of electronic note sharing in 2010. The results of that experiment--which used patient portals linked to EHRs to provide access to the notes--will be presented in a later paper.

The Harvard researchers received survey responses from 173 primary care physicians at the three sites. Of those doctors, 110 agreed to participate in the note-sharing trial; the rest declined. Nearly 38,000 patients completed the surveys.

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Overall, 69% to 81% of participating physicians in different sites agreed that sharing visit notes with patients would be a good idea, compared with 16% to 33% of nonparticipating doctors. In contrast, 92% to 97% of patients embraced the concept.

The most surprising finding of the patient survey was that nearly all patients--regardless of age, educational level, or health status--wanted to see their visit notes. About half said they planned to share the notes with caregivers and other providers or might do so.

Many physicians saw enhanced communication with patients as a major benefit of note sharing. Among the participating primary-care physicians (PCPs), 74% to 92% anticipated improvement in communication and patient education; but only 45% to 67% of the nonparticipating doctors agreed.

The majority of responding physicians expected that sharing notes would confuse some patients and increase their own work. "More than one half of participating PCPs (50% to 58%) and most nonparticipating PCPs (88% to 92%) expected that open visit notes would result in greater worry among patients; far fewer patients concurred (12% to 16%). Thirty-six percent to 50% of participating PCPs and 83% to 84% of nonparticipating PCPs anticipated more patient questions between visits," the paper said.

In an accompanying editorial, Thomas W. Feely, MD, of the University of Texas M.D. Anderson Cancer Center in Houston, and Kenneth I. Shine, MD, of the University of Texas in Austin, noted that the M.D. Anderson center has been sharing visit notes with patients since 2009. In that time, more than 40,000 patients have viewed their notes. Yet, "despite physician concerns that the system would increase workload and create unnecessary anxiety for patients, few have voiced complaints," they said.

The M.D. Anderson center example shows that this kind of information sharing won't bring practices to a grinding halt, said Tom Delbanco, M.D., a co-author of the study and a professor at Harvard Medical School, in an InformationWeek Healthcare interview. One reason, he said, is that "for every patient who bugs me more as a result of this, there's another patient who's bugging me less, because my note answered some of his or her questions."

The study found that many physicians believed that note sharing would change how they documented patient visits. Between 27% and 40% of participating PCPs and 61% to 75% of nonparticipating PCPs said they would be less candid in documentation.

Jan Walker, RN, lead author of the study and a health services researcher at Harvard and Beth Israel Deaconess Medical Center, said this will be a major area for investigation in the follow-up surveys. The clinical areas in which doctors indicate they'd be most likely to document differently are cancer, obesity, substance abuse, and mental health, she said.

As a physician, Delbanco said, he welcomed the opportunity to share notes with patients and hoped that it would lead to greater patient engagement and more productive conversations. "One of our greatest problems in medicine is how to more actively engage patients in their own care," he pointed out. "And what excites us about open visit notes and what led us to do this study is that we think this may be an important mechanism for engaging patients."

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