WILL ACCESS TO CLINICIANS’ NOTES IMPROVE PATIENT SAFETY?

I just came upon a stirring article in the New England Journal of Medicine , entitled “ The Road toward Fully Transparent Medical Records ” ( sic ). It’s a little long, but well worth reading, because it contains truly revolutionary ideas.

By now, everyone in the healthcare field, and some patients, have become aware of the increasing use of electronic medical records, or EMRs. Patients of cutting edge medical practices now have access to patient portals through which they can view some of their records, such as lab results, and can communicate with their physicians. My own primary care physician’s practice group has such a set up, and it has been quite useful to me. But as the authors of the NEJM article point out, patients have not had access to their clinician’s notes.  Physicians have been uneasy about granting such access, and understandably so. “Writing accurately about a suspicion of cancer…can be difficult for clinicians who don’t want to worry patients unnecessarily, and addressing character disorders or cognitive dysfunction in ways that are useful to patients, consulting providers and others…requires carefully considered words.” What the article did not address, but should have, is the concerns most physicians have about the role such transparency might have in exposing them to potential medical malpractice liability.

Yet there are significant benefits to such transparency, including improved patient safety, according to the authors. “[O]pen notes can help improve patient safety by allowing contributions from patients and families who may catch questionable statements or clinically important mistakes in notes or find lapses in follow-up that need to be rectified.”

Naturally, the easy availability of clinician’s notes has its downsides, too. As the author’s note, “patients may choose to post their provider’s progress notes on Facebook, Twitter, medical forums, and other social media, potentially exposing clinicians to public scrutiny.” But consider this. The authors believe that such open records will become the standard of care; that patients and doctors will participate in their creation; and that ultimately, both patients and doctors will sign off on them. And this collaborative process appears to be a good thing.

The study that is the focus of the authors’ article, OpenNotes, found that patients who read the notes had better understanding and recall of their care, and felt more involved in it. Compliance with taking medications improved. And the contents of the notes did not upset the patients who read them. So, isn’t this an idea whose time has come?