Patients, docs try OpenNotes Pilot project at Geisinger allows online access to records

DANVILLE - Both patients and doctors at Geisinger Medical Center are reporting early success in the OpenNotes Project, a 12-month study that could establish guidelines for improved health care communication in the future.

Although patients have the legal right to read their doctor's notes, very few do. As recent health care reforms aim to better educate patients and provide greater accessibility to records, Geisinger, Beth Israel Deaconess Medical Center in Boston and Harborview Medical Center in Seattle are taking part in OpenNotes, which started in June.

Funded through a $1.4 million grant from the Robert Wood Johnson Foundation (RWJF) Pioneer Portfolio, it involves approximately 12,000 Geisinger patients and 27 Geisinger doctors who are examining the impact of adding a new layer of openness.

Through the online MyGeisinger Web portal, patients and doctors are sharing comments and observations made by the doctor after each patient visit

"Patients want access to their records, and OpenNotes provides better access to information that rightfully belongs to them," said Dr. Jonathon Darer, co-principal investigator of OpenNotes.

Positive reaction

Dr. Stephen Lewis, an internal medicine/pediatric physician at Geisinger-Berwick who is participating in the study, said he has already seen a positive reaction from his patients.

"Patients have come in and said that they were looking forward to using the program and asking more questions," he said.

Lewis said it's common - before OpenNotes - to have patients send in letters asking to see their records.

"As long as it's beneficial to the patients, it's a good thing," he said. "The OpenNotes Project program can improve patient satisfaction and decrease the overall fear of asking questions. They can see our thought process as well as our plans."

Expected to go nationwide

The study currently consists of 12,000 patients, but plans are to expand it to as many as 160,000 as more patients show interest.

Darer believes the program will eventually be implemented in hospitals across the nation as patients become better educated.

"It's going to happen; patients are going to demand it," he said. "The online presence is a difference-maker. It may replace other forms of communication because patients are able to answer their own questions."

'Very satisfied'

Raymond Bowman, 85, of Valley View, Schuylkill County, is a patient who has been involved with the study for a month. Geisinger arranged a telephone interview with Bowman to discus OpenNotes.

"I'm very satisfied with the situation. It's nice to know what's going on after I leave the hospital," he said.

Bowman and the other patients enrolled in OpenNotes receive reminder e-mails that their notes are accessible online.

Bowman admits he isn't up to date with technology, as is the case for most patients, so it helps that his wife and other family members can see what happened during each of his visits.

"Sometimes there's language I don't always understand or things that I forget," he said. "It's important that my wife and family know so they can help manage my health."

For the patient

Patients have a legal right to obtain their paper records, which usually includes notes, but they often have to wait to get copies and must pay a fee. Online access, meanwhile, is quick, easy and free.

Patients generally retain only a portion of the information that is exchanged with their doctor, Darer said. He believes access to doctor's notes will reinforce information provided at the time of the doctor's visit. But, he said, doctors are split on the value of open access to their notes in patients' records.

In an earlier interview, Stephen Downs, an assistant vice president at RWJF and member of the foundation's Pioneer Portfolio, also said doctors had a strong difference of opinion about sharing notes. But, he said, it could "reposition notes to be for the patient instead of about the patient, which might have a powerful impact on the doctor-patient relationship and, in the long run, lead to better care."

Researchers hope to learn whether the increased transparency will increase patient-physician trust and communication, and better engage patients in managing their own care.

Both sides learn

By contrasting the experience of trial participants with physicians and patients who are not enrolled, the researchers hope to measure the impact access to the notes has on patients' engagement in their care.

Darer said there a lot of challenges to meet over the next couple years with the way doctors deliver care to patients. He said the key to overcoming these problems is patient education and better care.

"It gives patients a better understanding of the health care system while we learn what works to improve our care," he said.