Study allows patients to view physician notes

A new study in Massachusetts, Pennsylvania, and Washington will examine the effect of physicians sharing with patients, through online medical record portals, the comments and observations they make after each patient encounter.

About 100 primary care physicians and 25,000 patients at Beth Israel Deaconess Medical Center (BIDMC) in Boston, Geisinger Health System in Pennsylvania, and Harborview Medical Center in Seattle will participate in the 12-month OpenNotes project, funded through a $1.4 million grant from the Robert Wood Johnson Foundation (RWJF) Pioneer Portfolio.

"Doctors have strong differences of opinion about giving patients access to their notes. However, the debate is largely uninformed by evidence," says Stephen Downs, assistant vice president at RWJF and member of the its Pioneer Portfolio. "In the context of a physician's day-to-day work, opening up notes is 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."

To collect evidence, physicians and patients will share, through a one-step intervention, all encounter notes online. By contrasting the experience of trial participants with unenrolled physicians and patients, the researchers hope to measure the effect of OpenNotes through online surveys of both groups of doctors and patients.

"While this intervention potentially could disrupt the current flow of primary health care, it holds considerable potential to transform the doctor-patient relationship," says Tom Delbanco, MD, 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 (HMS). "By enabling patients to read their clinicians' notes, OpenNotes may break down an important wall that currently separates patients from those who care for them. It may promote insight and shared decision-making by bringing closer together the unique expertise of the clinician and the unique understanding of himself or herself that each patient possesses."