Little is known about what primary care physicians (PCPs) and patients would expect if patients were invited to read their doctors' office notes.
To explore attitudes toward potential benefits or harms if PCPs offered patients ready access to visit notes.
The PCPs and patients completed surveys before joining a voluntary program that provided electronic links to doctors' notes.
Primary care practices in 3 U.S. states.
Participating and nonparticipating PCPs and adult patients at primary care practices in Massachusetts, Pennsylvania, and Washington.
Doctors' and patients' attitudes toward and expectations of open visit notes, their ideas about the potential benefits and risks, and demographic characteristics.
110 of 114 participating PCPs (96%), 63 of 140 nonparticipating PCPs (45%), and 37 856 of 90 203 patients (42%) completed surveys. Overall, 69% to 81% of participating PCPs across the 3 sites and 92% to 97% of patients thought open visit notes were a good idea, compared with 16% to 33% of nonparticipating PCPs. Similarly, participating PCPs and patients generally agreed with statements about potential benefits of open visit notes, whereas nonparticipating PCPs were less likely to agree. Among participating PCPs, 74% to 92% anticipated improved communication and patient education, in contrast to 45% to 67% of nonparticipating PCPs. 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. Few PCPs (0% to 33%) anticipated increased risk for lawsuits. Patient enthusiasm extended across age, education, and health status, and 22% anticipated sharing visit notes with others, including other doctors.
Access to electronic patient portals is not widespread, and participation was limited to patients using such portals. Response rates were higher among participating PCPs than nonparticipating PCPs; many participating PCPs had small patient panels.
Among PCPs, opinions about open visit notes varied widely in terms of predicting the effect on their practices and benefits for patients. In contrast, patients expressed considerable enthusiasm and few fears, anticipating both improved understanding and more involvement in care. Sharing visit notes has broad implications for quality of care, privacy, and shared accountability.
The Robert Wood Johnson Foundation's Pioneer Portfolio, Drane Family Fund, and Koplow Charitable Foundation.
"Similarly, physicians who have experience of patients accessing their medical records tend to be more positive towards allowing patients' to access their records than their colleagues in the control groups. The same applies to post (patients less interested, physicians more positive) versus preimplementation studies (e.g., Ammenwerth et al., 2012; Walker et al., 2011; Ålander et al., 2004). One explanation of the prevalence of contradictory findings and the existence of conflicting views might relate to people struggling to maintain a balance between 'appropriate' and 'inappropriate' behaviors. "
[Show abstract][Hide abstract] ABSTRACT: Better knowledge of the habits and preferences of patients helps one understand why and how patients might need or want to access health services online and offline. Such knowledge provides a basis for designing systems for providing complementary health information. This article discusses how patients' conceptualizations of their health-information-related preferences, motivations, and needs are linked to the perceived role of medical records as an informational artifact. We identified seven subject positions: (P1) Hypothetically positive to e-health services generally, (P2) Positive to reading medical records due to implications, (P3) Positive to all Internet use including medical records online, (P4) Distrustful and wants to be in control of health treatment, (P5) Worried about health, (P6) Wants communication with health care professionals, and (P7) Do not understand their medical record. These subject positions can explain the worry and enthusiasm documented in earlier literature. The diversity of subject positions implies that health care information services should be planned with different subject positions in mind rather than a simple demographic group. Special attention needs to be given to finding flexible solutions that address the opportunities and worries of the identified subject positions.
Journal of the Association for Information Science and Technology 05/2015; DOI:10.1002/asi.23343 · 2.23 Impact Factor
"ients' lack of access to their EMRs and the implications for possible errors and treatment, Dr. Leana Wen (2014) started sharing her charts with her patients, promoting patients' access to their doctors' notes about them. This practice led to the establishment of the Open Notes project (see www.myopennotes.org) in 2010. Delbanco et. al. (2012) and Walker et. al. (2011) report that increasing patients' access to their medical records empowers them to detect errors and rectify information in their histories while also improving patients' understanding of their conditions and their adherence to medical treatment. This dynamic creates a more fluid working partnership with doctors."
[Show abstract][Hide abstract] ABSTRACT: Diagnostic errors remain an underemphasised and understudied area of patient safety research. We briefly summarise the methods that have been used to conduct research on epidemiology, contributing factors and interventions related to diagnostic error and outline directions for future research. Research methods that have studied epidemiology of diagnostic error provide some estimate on diagnostic error rates. However, there appears to be a large variability in the reported rates due to the heterogeneity of definitions and study methods used. Thus, future methods should focus on obtaining more precise estimates in different settings of care. This would lay the foundation for measuring error rates over time to evaluate improvements. Research methods have studied contributing factors for diagnostic error in both naturalistic and experimental settings. Both approaches have revealed important and complementary information. Newer conceptual models from outside healthcare are needed to advance the depth and rigour of analysis of systems and cognitive insights of causes of error. While the literature has suggested many potentially fruitful interventions for reducing diagnostic errors, most have not been systematically evaluated and/or widely implemented in practice. Research is needed to study promising intervention areas such as enhanced patient involvement in diagnosis, improving diagnosis through the use of electronic tools and identification and reduction of specific diagnostic process 'pitfalls' (eg, failure to conduct appropriate diagnostic evaluation of a breast lump after a 'normal' mammogram). The last decade of research on diagnostic error has made promising steps and laid a foundation for more rigorous methods to advance the field.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.