Wednesday, February 11, 2015

The OpenNotes Movement Is Gathering Pace and Seemingly Making A Difference - All Good!

This appeared a little while ago.

OpenNotes: 'This is not a software package, this is a movement'

Posted on Jan 08, 2015
By Mike Miliard, Editor
Tom Delbanco, MD, professor of general medicine and primary care at Harvard Medical School and former chief of general medicine at Beth Israel Deaconess Medical Center, is also co-director of the OpenNotes project, which gives patients access to the clinical notes written by their doctors and nurses.
OpenNotes initially launched in 2010 as a pilot program in three select locations: BIDMC, Geisinger Health System and Harborview Medical Center in Seattle. It soon became apparent that what may have seemed, at first, to be a revolutionary concept had struck a nerve.
Over the past five years, the initiative -- which Delbanco first developed alongside BIDMC researcher Jan Walker, RN -- has grown almost exponentially, finding footholds at some of the largest and most prestigious providers in the country, including the VA, Kaiser Permanente Northwest, Oregon Health & Science University and University of Colorado Health.
On Feb. 10, at the Healthcare IT News/HIMSS Media Patient Engagement Summit, at the Hyatt Regency in Orlando, Delbanco’s BIDMC colleague, National OpenNotes Program Director Melissa Anselmo, will talk about why OpenNotes is such a hit with patients – and, despite some initial resistance, most of the physicians who take part in it as well.
In the meantime. Delbanco describes how the project has evolved thus far, and how it plans to expand to a truly nationwide movement.  
Q: OpenNotes has experienced some pretty impressive growth since that first pilot in 2010.
A: We've gone from 20,000 people two years ago to, we think, between 4.5 million and 5 million now, who have access to their notes via secure electronic portals.
Q: Clearly this is an idea that had legs. So how did it all get started?
A: I've always thought the medical record is the hub of the wheel, the way to bring patients much closer to those who care for them. I did an experiment 30 years ago where I actually had patients walking around this hospital with records they kept – and writing their own records along with the doctors writing theirs – and saying, 'Let's compare notes.' We published a paper about that, the doctors thought the patients were crazy. It was a little early.
Then we got a grant (in 2010) from the Robert Wood Johnson Foundation to try this out in a big way using electronic portals. We asked doctors to volunteer in three settings. One is Beth Israel Deaconess, one of the big Harvard teaching hospitals. Another is the Geisinger Health System, which is this enormous integrated health system, serving rural Pennsylvania. And the third is Harborview, a safety net hospital in Seattle. We wanted three very different sites.
A lot of doctors told us to go to hell. But we got more than 100 to volunteer – primary care doctors – which meant that automatically their patients who were registered on portals would be part of the study. There were about 20,000 of them.
Q: Did you notice any differences between those three very different locales?
A: We found extraordinarily few differences, which was very interesting. Much fewer than we expected. Part of what helped our study was that we didn't just do it in one place, and that the findings, from both doctors and patients, were so similar. People felt it really had some generalizability to it.
The intervention was very simple: After the doctor signed his or her note, the patient automatically got an email saying, "Tom just signed his note; Mike, you're welcome to read, it." And then, two weeks before your appointment with your primary care doctor, you got a reminder email saying, "You might want to review your notes."
That's all there was to it. A very simple intervention. All the vendors have them. But what's been hidden, up to now, is what the doctor writes, and what he or she thinks about you. You can look up your lab work, you can look up your X-ray results, you can send secure emails, you can ask for appointments and refills. But you have not, in the past, been able to look up what the doctor wrote about you. That's what the disruptive innovation is.
Lots more here:
At the same time we had this:

Patients to Take Control of Data in ‘Democratization’ of Medicine

JAN 8, 2015 7:48am ET
Eric Topol, M.D., chief academic officer of Scripps Health in San Diego, is many things. He is a practicing cardiologist, a geneticist, a researcher, and a bestselling author.
In his 2012 book The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Healthcare, Topol argues that the healthcare industry is in the beginning phases of its “creative destruction”—a term coined by economist Joseph Schumpeter to describe the revolutionary process by which innovation replaces old industries with new ones. At the heart of this digital-medical revolution, he asserts, is a fundamental shift in who accesses and “owns” medical data and health information—a transfer of power from doctors to consumers.
Now, Topol has come out with a new book, The Patient Will See You Now: The Future of Medicine is in Your Hands, continuing his theme of consumer empowerment. Just as Gutenberg’s printing press spread literature to the masses for the first time in history, he makes the case that smartphones and other mobile devices in the hands of patients will serve to “democratize medicine” giving them control of their data—which has historically been the domain of physicians.
Health Data Management spoke to Topol about his latest book and the future of medicine.
Lots more here:
and this:

Mental Health Notes-Sharing Pilot Seen as Success

JAN 8, 2015 7:32am ET
Clinicians and patients participating in a pilot implementation of the OpenNotes note-sharing program for mental health treatment at Boston's Beth Israel Deaconess Medical Center say the program has yielded tangible benefits.
As of Dec. 1, 2014, hospital executives said approximately 85,000 BIDMC patients use the hospital's PatientSite portal to manage their care, and about 1,000 of those had access to their mental health notes since the pilot began in March.
“We can certainly say at this point, the angst which most clinicians feared by sharing their notes is not materializing,” said Stephen O’Neill, social work manager for psychiatry and primary care. “It has been strikingly quiet in this regard, with scattered exceptions. The vast majority of our patients are reporting that the notes are helpful and often clarifying. OpenNotes is not an end, it is one more means in giving our patients tools to assist them. Most patients report that it helps them to feel more in charge of their life and in a better ‘partnership’ with their clinical team.”
Again more here:
It seems this is the way many / most patients would like to interact and share information with their doctor.
Technologists need to work out what is the best way it can be supported and delivered - in the Australian setting. I am certain the PCEHR will not cut it - great big collection of .pdfs it is about to become!

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