Open Records Pilot Project Looks To Reinvigorate Patient-Physician Dialogue
Allowing patients access to their personal medical records is a decades-old idea that predates electronic medical records. Yet, the idea has yet to catch on.
Susan Frampton, president of Planetree, says the association of patient-centered care healthcare providers has for the last 20 years asked its members to allow patients access to their medical records, but with limited results. Of the 150 acute care hospitals in Planetree, only about 25% have opened their records to patient scrutiny.
"It has probably been the one most challenging practices that we have asked our members to do," Frampton says. "There is a lot of fear on the part of medical and nursing staff and that translates into resistance, in part because they are afraid of the potential for litigation if the patient reads something in their chart that they don't like the sounds of."
Hospitals and physicians in three states announced this week a 12-month pilot project that they hope will rekindle the movement and measure the impact of patient access to medical records. Funded through a $1.4 million grant from the Robert Wood Johnson Foundation Pioneer Portfolio, the OpenNotes Project will evaluate the impact on both patients and physicians of sharing, through online medical record portals, the comments and observations made by physicians after each patient encounter.
The pilot project will involve about 100 primary care physicians and 25,000 patients at Beth Israel Deaconess Medical Center in Boston, Geisinger Health System in Pennsylvania, and Harborview Medical Center in Seattle.
"Patients remember precious little about what happens in the doctor's office," said Tom Delbanco, MD, a primary care physician at BIDMC and a Harvard Medical School professor, in a media release. "We expect OpenNotes will improve patient recall, help patients take more responsibility for their care, and offer an opportunity for avoiding potential medical errors as patients and families monitor and think about their care in a much more active and knowledgeable way."
Delbanco and Jan Walker, RN, an instructor in medicine at BIDMC and Harvard Medical School, recently coauthored a report in Journal of General Internal Medicine that found that most consumers want full access to their medical records.
"We learned that, for the most part, patients are very comfortable with the idea of computers playing a central role in their care," Walker said, adding that patients expect that in the near future they will be able to rely on electronic technology for many routine medical issues.
Frampton says the problem isn't convincing the patients. The problem is convincing the medical staff and nurses who fear potential lawsuits, even though hospitals that have opened their patient records are reporting a decrease in lawsuits.
"There is still this misperception that patients might see something they don't like or aren't prepared for so that could be a liability," Frampton says. "If you look at the malpractice literature, patients don't sue because there is something in the charts they don't like. They sue because they feel abandoned or that nobody is paying attention to them or things are being hidden from them."
Frampton says there is also resistance from the nursing staff. "There may be things in the charts that the nurses aren't fully prepared to discuss with the patients," she says. "Maybe it's the doctor's notes and the patient questions the nurse and the nurse may feel like he or she is caught in between."