Tom Delbanco

Tom Delbanco
Harvard University | Harvard · Medicine

MD

About

243
Publications
35,487
Reads
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17,133
Citations
Additional affiliations
June 2014 - present
Harvard Medical School
Position
  • Koplow-Tullis Professor of General Medicine and Primary Care
Description
  • Current research focusing on "OpenNotes," fully transparent medical records (www.myopennotes.org)
June 2014 - present
Beth Israel Deaconess Medical Center
Position
  • Member, Division of General Medicine and Primary Care

Publications

Publications (243)
Preprint
BACKGROUND Patients are uniquely positioned to document both their subjective experiences and goals for a medical encounter. OBJECTIVE To assess the effects of 12-month pilot interventions of co-generated visit notes. METHODS Patients at 6 primary care practices in 4 academic health centers were asked to provide unstructured interval histories an...
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Background Secure patient portals are widely available, and patients use them to view their electronic health records, including their clinical notes. We conducted experiments asking them to cogenerate notes with their clinicians, an intervention called OurNotes. Objective This study aims to assess patient and provider experiences and attitudes af...
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Background Sharing outpatient notes with patients may bring clinically important benefits, but notes may sometimes cause patients to feel judged or offended, and thereby reduce trust.Objective As part of a larger survey examining the effects of open notes, we sought to understand how many patients feel judged or offended due to something they read...
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In the absence of international standards, widely differing attitudes and laws, medical and social cultures strongly influence whether and how patients may access their medical records in various settings of care. Reviewing records, including the notes clinicians write, can help shape how people participate in their own care. Aided at times by new...
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This paper connects findings from the field of placebo studies with research into patients’ interactions with their clinician’s visit notes, housed in their electronic health records. We propose specific hypotheses about how features of clinicians’ written notes might trigger mechanisms of placebo and nocebo effects to elicit positive or adverse he...
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Background Patients actively involved in their care demonstrate better health outcomes. Using secure internet portals, clinicians are increasingly offering patients access to their narrative visit notes (open notes), but we know little about their understanding of notes written by clinicians.Objective We examined patients’ views on the clarity, acc...
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Importance As health information transparency increases, patients more often seek their health data. More than 44 million patients in the US can now readily access their ambulatory visit notes online, and the practice is increasing abroad. Few studies have assessed documentation errors that patients identify in their notes and how these may inform...
Article
Millions of people manage their health and illness with the help of family members and friends. These informal care partners (or caregivers) take responsibility, sometimes at a cost to their own health,¹ for a wide variety of tasks, including arranging and attending medical appointments, participating in decision-making, coordinating services, and...
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Importance The 21st Century Cures Act of 2016 requires that patients be given electronic access to all the information in their electronic medical records. The regulations for implementation of this law give patients far easier access to information about their care, including the notes their clinicians write. Objective To assess clinicians’ views...
Preprint
BACKGROUND Following a 2010-2011 pilot intervention that offered primary care patients secure online portal access to their doctors’ office visit notes, these systems expanded “OpenNotes” to nearly all clinicians in primary care, medical and surgical specialty practices. OBJECTIVE To examine the ongoing experiences and perceptions of patients who...
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Full-text available
Background: Following a 2010-2011 pilot intervention in which a limited sample of primary care doctors offered their patients secure Web-based portal access to their office visit notes, the participating sites expanded OpenNotes to nearly all clinicians in primary care, medical, and surgical specialty practices. Objective: The aim of this study...
Article
Background: OpenNotes, a national movement inviting patients to read their clinicians' notes online, may enhance safety through patient-reported documentation errors. Objective: To test an OpenNotes patient reporting tool focused on safety concerns. Methods: We invited 6225 patients through a patient portal to provide note feedback in a qualit...
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Das Open-Notes-Projekt verfolgt in den USA das Ziel, das Arzt-Patienten-Verhältnis und die Patientenaufklärung zu verbessern. Eine erste Evaluation zeigt, dass es vielfältige positive Erfahrungen gibt, sowohl von Patienten, aber auch von Ärzten.
Article
We examined the acceptability and effects of delivering doctors’ visit notes electronically (via OpenNotes) to patients and care partners with authorized access to patients’ electronic medical records. Adult patients and care partners at Geisinger Health System were surveyed at baseline and after 12 months of exposure to OpenNotes. Reporting on car...
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Background Patient advocates and safety experts encourage adoption of transparent health records, but sceptics worry that shared notes may offend patients, erode trust or promote defensive medicine. As electronic health records disseminate, such disparate views fuel policy debates about risks and benefits of sharing visit notes with patients throug...
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Objective To examine whether patients invited to review their clinicians’ notes continue to access them and to assess the impact of reminders on whether patients continued to view notes. Materials and methods We followed OpenNotes trial participants for 2 years at Beth Israel Deaconess Medical Center (BIDMC) and Geisinger Health System (GHS). Elect...
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Objectives (A) To gain insights into the experiences of patients invited to view their doctors’ visit notes, with a focus on those who review multiple notes; (B) to examine the relationships among fully transparent electronic medical records and quality of care, the patient-doctor relationship, patient engagement, self-care, self-management skills...
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The OpenNotes project in the USA aims at improving the doctor-patient relationship as well as patient education, among others. First evaluations have reported multiple benefits, from patients but also from doctors.
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Background: As health care costs alarm the nation and the debate increases about the impact of health information technologies, patients are reviewing their medical records increasingly through secure Internet portals. Important questions remain about the impact of portal use on office visits. Objective: To evaluate whether use of patient Intern...
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Background: In surveys, interviews, and focus groups, patients taking medications and offered Web portal access to their primary care physicians' (PCPs) notes report improved adherence to their regimens. However, objective confirmation has yet to be reported. Objective: To evaluate the association between patient Internet portal access to primar...
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The move to offer patients online access to their clinicians’ notes is accelerating and holds promise of supporting more truly collaborative relationships between patients and clinicians, say Jan Walker, Michael Meltsner, and Tom Delbanco
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Inviting patients to read their primary care visit notes may improve communication and help them engage more actively in their health care. Little is known about how patients will use the opportunity to share their visit notes with family members or caregivers, or what the benefits might be. Our goal was to evaluate the characteristics of patients...
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In Reply Dr Ritter raises difficult questions. Adults are increasingly reviewing clinicians’ notes, and we expect that adolescents and younger children, raised with ever-evolving social media, will be interested in what is being written about them in medical records. Even though some clinicians are beginning to offer adults access to their mental h...
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Patients living with HIV/AIDS face large societal and medical challenges. Inviting patients to read their doctors' visit notes via secure electronic portals may empower patients and improve health. We investigated whether utilization and perceptions about access to doctors' notes differed among doctors and patients in an HIV/AIDS clinic versus prim...
Article
Should we health professionals encourage patients with mental illness to read their medical record notes? As electronic medical records and secure online portals proliferate, patients are gaining ready access not only to laboratory findings but also to clinicians’ notes.1 Primary care patients report that reading their doctors’ notes brings many be...
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Forty years ago, Shenkin and Warner argued that giving patients their medical records "would lead to more appropriate utilization of physicians and a greater ability of patients to participate in their own care."(1) At that time, patients in most states could obtain their records only through litigation, but the rules gradually changed, and in 1996...
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Offering patients online access to medical records, including doctors' visit notes, holds considerable potential to improve care. However, patients may worry about loss of privacy when accessing personal health information through Internet-based patient portals. The OpenNotes study provided patients at three US health care institutions with online...
Article
At a time of societal fascination both with transparency and the explosion of health information technologies, a growing number of hospitals are offering, or will soon offer patients and their family instantaneous access to their doctors' and nurses' notes. What will this new opportunity for patient engagement mean for the hospitalist? Today, state...
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Little information exists about what primary care physicians (PCPs) and patients experience if patients are invited to read their doctors' office notes. To evaluate the effect on doctors and patients of facilitating patient access to visit notes over secure Internet portals. Quasi-experimental trial of PCPs and patient volunteers in a year-long pro...
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Background: As the use of electronic medical records (EMRs) spreads, health-care organizations are increasingly offering patients online access to their medical records. Studies evaluating patient attitudes towards viewing elements of their records through secure, electronic patient portals have generally not included medically underserved patient...
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Full-text available
Providers and policymakers are pursuing strategies to increase patient engagement in health care. Increasingly, online sections of medical records are viewable by patients though seldom are clinicians' visit notes included. We designed a one-year multi-site trial of online patient accessible office visit notes, OpenNotes. We hypothesized that patie...
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The authors developed a computer-based general medical history to be taken by patients in their homes over the internet before their first visit with their primary care doctor, and asked six doctors and their participating patients to assess this history and its effect on their subsequent visit. Forty patients began the history; 32 completed the hi...
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Background: Little is known about what primary care physicians (PCPs) and patients would expect if patients were invited to read their doctors' office notes. Objective: To explore attitudes toward potential benefits or harms if PCPs offered patients ready access to visit notes. Design: The PCPs and patients completed surveys before joining a v...
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Full-text available
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 elect...
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In a Clinical Crossroads article published in January 2010,¹ Jean Kutner, MD, MSPH, discussed decision making concerning end-of-life care and the use of hospice. The patient, Mrs H, was an introspective 86-year-old woman with progressive congestive heart failure and multiple comorbidities, including varying degrees of depression. She required assis...
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Accountability in medicine, once assigned primarily to individual doctors, is today increasingly shared by groups of health-care providers. Because patient safety experts emphasize that most errors are caused not by individual providers, but rather by system breakdowns in complex health-care teams, individual doctors are left to wonder where their...
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To investigate organizational facilitators and barriers to patient-centered care in US health care institutions renowned for improving the patient care experience. A qualitative study involving interviews of senior staff and patient representatives. Semi-structured interviews focused on organizational processes, senior leadership, work environment,...
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The authors developed a computer-based medical history for patients to take in their homes via the internet. The history consists of 232 'primary' questions asked of all patients, together with more than 6000 questions, explanations, and suggestions that are available for presentation as determined by a patient's responses. The purpose of this rese...
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Few patients read their doctors' notes, despite having the legal right to do so. As information technology makes medical records more accessible and society calls for greater transparency, patients' interest in reading their doctors' notes may increase. Inviting patients to review these notes could improve understanding of their health, foster prod...
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Full-text available
Few patients read their doctors' notes, despite having the legal right to do so. As information technology makes medical records more accessible and society calls for greater transparency, patients' interest in reading their doctors' notes may increase. Inviting patients to review these notes could improve understanding of their health, foster prod...
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The emotional toll of medical error is high for both patients and clinicians, who are often unsure with whom-and whether-they can discuss what happened. Although institutions are increasingly adopting full disclosure policies, trainees frequently do not disclose mistakes, and faculty physicians are underprepared to teach communication skills relate...
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In the first of 136 Clinical Crossroads articles published in JAMA since 1995, Peter C. Albertsen, MD, discussed Mr S, a 72-year-old man with localized prostate cancer.¹ In 1992, Mr S was found by Dr K, his primary physician, to have slight induration of his prostate on a routine physical examination. A consulting urologist confirmed the finding an...
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Full-text available
In designing electronic personal health records (PHRs) and related health technologies, lay perspectives are rarely solicited, and we know little about what individuals want and need. To learn how diverse, primarily lay individuals envision how PHRs and other emerging and future electronic technologies could enhance their care. Qualitative study of...
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In a Clinical Crossroads article published in April 2006,1 Gordon J. Strewler, MD, discussed the epidemiology and pathophysiology of primary hyperparathyroidism, as well as the medical and surgical treatment options. The patient, Ms Q, had a history of hypercalcemia first noted on random testing in 2001. Her initial calcium level was 11.3 mg/dL, an...
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How can we characterize and address the human dimensions of medical error so that patients, families, and clinicians may reach some degree of closure and move toward forgiveness? Drs. Tom Delbanco and Sigall Bell address these questions.
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In November 2004, Joseph Carrozza, MD, an interventional cardiologist, and Frank Sellke, MD, a cardiac surgeon, discussed the short and long-term clinical outcomes of interventions designed to manage coronary artery disease involving the left main artery.1 The patient, Mrs D, had multiple risk factors for coronary artery disease and was taking nitr...
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In the supply of mental health services to communities, data and information are managed not only by clinical organizations, but also by welfare state agencies and charities. The aim of this study is to use methods of analysis from actor network theory to identify organizational interventions necessary for the development of an information infrastr...
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In Reply: Dr Sack correctly notes that our patient preferred yearly endoscopy as surveillance for her gastroesophageal reflux disease and Barrett esophagus, and that her physician complied with her request. This is contrary to the recommendation of Dr Spechler in his original Clinical Crossroads publication.¹ He felt her risk of developing esophage...
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Phones seem antagonistic these days, [and] I'm not sure I can process health stuff that quickly. With e-mail I can address issues when I have the mental space. I have time to think and shape the question and keep a file. And my doctor . . . helps me think things through. He has really gotten to know me and my evolving circumstance. — A patient in o...
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Cooper and colleagues found that when patients and doctors were of the same race, they spent more time together during office visits and patients were more satisfied than when doctors were of a different race. These findings move us to the top of a slippery slope. Given that "separate but equal" should never be a goal, any move that segregates some...
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Financial and time pressures, disparate promotional pathways, geographic separation, and difficulty acknowledging personal fallibility can contribute to polarization of clinician-educators and investigators in general internal medicine (GIM). As a consequence, clinician-educators and investigators may fail to use their joint expertise, may encounte...
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Poor communication and distance may result when the perspectives of clinicians and patients differ. Individual interviews, focus groups, and surveys of patients can inform health professionals about patient expectations and experiences with care. Hospital medicine will advance by learning from patients and their families and involving them in effor...
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At a time when walls seem to be rising higher inexorably between patients and clinicians, two strategies may stimulate change and lead to health care systems very different from those currently in place. The first is to bring organized, structured feedback systems into place, with patients and their families serving as expert witnesses to their car...