Friday, January 31, 2014

How Much Access Should Patients Have To Their Medical Records? The More The Better It Seems!

This appeared a few days ago.

Is it wise to let patients read your notes?

16 January, 2014
Giving patients immediate access to doctors' medical notes following a consultation is being touted as a new standard of care following a US study.
The year-long OpenNotes study involved sending 20,000 patients a secure message following consultations with their GPs inviting them to read the doctor's notes via an online portal.
Jan Walker, from the Beth Israel Deaconess Medical Centre, in Boston, US, said many doctors had been wary of the project, concerned about increased workflow and what she described as an "avalanche" of questions from patients about the information in their medical notes.
"They were also really worried about the impact on their patients, whether the notes would be confusing or worrisome," she said in an interview with the New England Journal of Medicine.
Researchers found that about 80% of the patients used the system to read their notes — but there were no incidents of patients being harmed as a result of accessing the information.
"We were surprised that it went across all types of patients, including the elderly and those with chronic illness and those with only high school education," Ms Walker said.
"They said they understood more about their care, that they felt more control."
She added: "Doctors [also] reported very little impact on their workflow.
"In fact, they heard very little from patients throughout the study ... a minority of doctors did report that they changed how they wrote about cancer, substance abuse and mental health and obesity.
"They said they used fewer acronyms, adding more explanation to the note as they wrote it."
Doctors continued to make the ultimate decision on whether records were amended or updated.
In an editorial, called the Road Toward Fully Transparent Medical Records, the authors wrote: "Despite the challenges, nearly two million Americans already have access to notes, and we anticipate that open records will become the standard of care, accompanied by electronic tools that explain medical terminology and abbreviations, translate notes into different languages, and adjust for health-literacy levels.
The full article here:
Clearly there are some patients for whom this may not be a great idea (the seriously mentally ill and the mentally impaired possibly) but for the vast majority the US experience seems to be very, very positive.
The question with all this is how it can be best implemented with minimal disruption for those clinicians and patients for whom it makes sense while maybe using a different approach for psychiatrists. Children’s medical records may need special care as they become more autonomous as teenagers
The practicalities of achieving this is an electronic world also needs careful consideration. I seriously don’t believe the PCEHR is any sort of answer for this - and that the Kaiser / UK approach of providing portal access to the primary record would be a better tack to adopt.
I think this is likely to be a trend we will see a great deal more of over time.

1 comment:

Anonymous said...

Yes patients should be offered access to their medical records, absolutely, but not just via an online portal. This should be made available to patients in an offline format as well, for those not comfortable with e-health.