Will “Open Notes” Change EMR Design?

Posted on April 26, 2012 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

Today I read about a very interesting project focused on improving relationships between physicians and patients. I suspect the concept would make some doctors’ skin crawl — anytime you’re asked to give up over control of information, it smarts a bit — but I suspect we’re seeing a glimpse of the future.

The  OpenNotes project, which is being conducted at Beth Israel Deaconess Medical Center, Geisinger Health System and Seattle’s Harborview Medical Center, lets patients review the notes, e-mails and phone calls primary care doctors make after their medical appointment. Patients access the information via a secure Web interface.

In July 2010, researchers published baseline findings prior to the OpenNotes kickoff in the Annals of Internal Medicine. Since then, the project seems to have attracted a lot of interest, with more than 100 doctors and 20,000 patients participating.   It’s also gotten a lot of support from foundations;  the group has received grants from the Robert Wood Johnson Foundation Pioneer portfolio, the Drane Family Fund, the Koplow Family Foundation and the Katz Family Foundation.

Wondering how participants feel about this level of medical intimacy? Check out the OpenNotes site, where you’ll find a video  offering impressions from patients and doctors on how they feel about their level of communication.  As you’ll see, OpenNotes volunteer patients seem to enjoy having a closer relationship with their doctor, and more importantly, feel empowered to comment or even contradict the doctor if they see something that seems to be out of line.

“You can look at the comments that Bob writes down and sometimes you agree with him and sometimes you don’t,” says one patient. “Sometimes we clash on it, but then we work things out.” (Note the familiar title “Bob” the patient uses to address his doctor, which I doubt he would have otherwise.) Sounds like a better working relationship than I have with most of my providers!

Of course, there’s always questions as to whether approaches like these would work outside the confines of a grant-funded, academically-minded group of institutions and doctors.  Certainly that’s hard to tell. But it seems clear that at minimum, something worthwhile is going on here that might force vendors to think about patient facing data more deeply.  I’m impressed by what I see here and hope that we continue to learn from these efforts.