Patients to soon have easier access to their doctors' notes

Area health systems, medical groups adopting initiative

By Marissa Harshman, Columbian health reporter

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More than 1 million people in Oregon and Southwest Washington will soon have easy access to the notes their providers write during medical appointments.

Nine area health systems and medical groups announced Tuesday they are adopting the OpenNotes initiative, a national movement urging health organizations to give patients open access to clinician notes. The organizations adopting the initiative are Kaiser Permanente Northwest, Legacy Health, The Vancouver Clinic, Oregon Health & Science University, Providence Medical Group Oregon, The Portland Clinic, Portland Veterans Affairs Medical Center, Salem Health and OCHIN, a health information network.

“We felt there was so much opportunity to help our patients,” said Dr. Michael McNamara, chief medical information officer for Kaiser Permanente Northwest.

Patients have always had the legal right to obtain copies of their physicians’ notes. But getting them can be a lengthy process requiring formal requests and processing time. The OpenNotes initiative, however, gives patients direct access to the notes through the patient portal on their provider’s website.

Each of the organizations will implement the initiative sometime this year or next. Kaiser Permanente rolled out the program Tuesday. The Legacy Medical Group will start its implementation with a select group of providers next week and will continue adding providers throughout the year. The Vancouver Clinic will begin with a pilot program May 1 and anticipates unveiling it clinic-wide this summer. The VA opened up its notes to patients in January 2013.

The regional collaboration marks the first widespread adoption of the OpenNotes initiative, though it has been implemented at individual organizations across the country, including the Mayo Clinic and the Cleveland Clinic, according to We Can Do Better, the nonprofit behind the initiative.

The initiative began with a one-year study at three sites, including Harborview Medical Center in Seattle. During the study, more than 13,000 patients cared for by 105 primary care physicians had access to their providers’ notes.

Patients reported feeling more in control of their care, having greater understanding of their medical conditions and being more likely to take their medications as prescribed. At the end of the year, 99 percent of patients asked for the practice to continue and none of the doctors chose to withdraw.

The study was compelling enough to prompt the Kaiser leadership to implement the program, McNamara said.

“Very few things are perceived by the patient to be this helpful,” he said.

And providing the notes doesn’t appear to create additional work for providers, at least it didn’t in the study, said Dr. Marcia Sparling, medical director for operations and information technology at The Vancouver Clinic.

The notes didn’t lead to a flood of patient calls asking for additional explanation. While a few people did call with questions, most people just used the Internet to look up unfamiliar words or phrases, Sparling said.

For the most part, providers won’t change how they write the notes. They will still be a working, technical document, Sparling said. Providers will, however, take care in using acronyms that could be interpreted as offensive, Sparling and McNamara said.

For example, providers often use “SOB” for “shortness of breath” or “FU” for “follow-up.” Now, providers will likely just spell out those phrases, they said.

Providers will also have to be aware of including items they didn’t discuss with patients, McNamara said. For example, if a provider was trying to diagnose a patient condition and wanted to include the remote possibility of cancer in the notes, he or she would need to bring that up during the visit to avoid surprising the patient in the notes, he said.

Dr. Kelley Aurand, a family medicine doctor with Legacy Medical Group — Fisher’s Landing, hopes the additional access will help to engage patients — and caregivers for elderly patients — in their health care.

“I think it’s the exciting next step as patients utilize their personal health records to become more involved in their care,” Aurand said. “We want our patients to be partners with us, and OpenNotes is just one more way they can do that.”