DANVILLE - Some 120,000 Geisinger Health System (GHS) patients will have digital access to their doctors' notes starting today.

Expansion of the OpenNotes initiative will include more than 500 Geisinger physicians, about half of its medical staff.

"One of the great challenges in medicine is getting patients involved in their own care," said Dr. Jonathan Darer, chief innovation officer for the Division of Clinical Innovation at GHS, and Geisinger's lead investigator on the project. "It's clear that providing patients access to their doctors' notes can be a powerful tool in accomplishing that goal."

Patients get access to doctors' notes by signing up to use the secure MyGeisinger patient online portal.

"This method is very simple as the notes will be typed out and easily readable on the computer screen," said Geisinger media relations representative Amanda O'Rourke.

The 120,000 patients who will have access starting today are just a portion of Geisinger's 2.6 million patients.

'Astonishing' participation

Funded through a $1.4 million grant from the Robert Wood Johnson Foundation, a 12-month OpenNotes trial project brought together 105 primary care doctors and more than 19,000 of their patients to evaluate the impact on both patients and physicians of sharing doctors' notes after each patient encounter. Led by Dr. Tom Delbanco and registered nurse Jan Walker, of Boston's Beth Israel Deaconess Medical Center (BIDMC), the study included 24 primary care physicians and 8,700 patients at Geisinger, and additional patients and physicians from BIDMC and Harborview Medical Center, Seattle, Wash.

Findings from this pilot published in the October Annals of Internal Medicine indicated that patients enthusiastically supported seeing their medical notes and no doctors said they wanted to opt out at the end of the study.

The study showed that patients read their notes and felt more engaged when they did so. Close to 11,200 patients - approximately 82 percent - opened at least one note contained in their electronic medical records. Of 5,391 patients who opened at least one note, 77 to 87 percent across the three sites reported that OpenNotes made them feel more in control of their care and helped them adhere to their medication regimens.

"To have 82 percent of patients open their notes is astonishing," Darer said. "It speaks volumes as to how important this information is to them."

Only a few patients reported increased worry, confusion or offense due to seeing their doctors' notes. Eighty-five percent of patients reported that having access to their doctors' notes would influence their choice of providers in the future.

More in future

These findings were in contrast to the concerns voiced by nonparticipating physicians, who worried that giving patients easy access to doctors' notes would result in additional work for them and could offend patients.

"As doctors, we know that patients generally retain only a portion of the information that is exchanged with their doctor during an office visit," Darer said. "One of our hopes with OpenNotes was that facilitating access to doctors' notes would engage patients and potentially help them remember more of what was discussed during the visit."

Given the promise that OpenNotes holds for patient engagement, Geisinger expects to offer this to more of its patients in the future. "We are moving very quickly to expand the program to offer this service to as many of our patients as we can," Darer said.

"I'm thrilled that one of the nation's premier health systems, and one of the three initial OpenNotes study sites, is taking this important step to share notes with patients," said Steve Downs, chief technology and information officer at the Robert Wood Johnson Foundation. "We hope other systems will follow Geisinger's lead to help patients get information they can use to participate more meaningfully in their care."

The doctors involved encompass all of primary care and general pediatrics, and selected physicians within pediatric subspecialties, dermatology, endocrinology, pulmonology, nephrology, rheumatology, cardiology, cardiothoracic surgery, vascular surgery, neurosurgery, and women's health - including obstetrics and gynecology and gynecologic oncology.