- A new study in JAMA Network Open concludes clinicians are favorable to what was once fairly inconceivable: Sharing their notes with patients (in an electronic format), which even the study's authors said was a "fringe idea" only a decade ago.
- From a survey of more than 1,600 physicians, nurse practitioners, physician assistants and therapists, 74% thought it was a good idea, and 61% said they would recommend the practice to colleagues. Three-quarters also thought it would be helpful if they knew when their patients were reading their notes — a feature very few EHR vendors offer, according to the study. The report did not delve into the massive HIT investment required to create portals for patients to view their medical records.
- However, the study also suggested that clinicians sharing notes with their patients are also spending more time on documenting encounters, and are also more likely to modify their approach to writing notes.
For decades, the physician-patient relationship was mostly a one-way street. If you wanted to know what your doctor had put in your records, you usually had to ask them directly, and some might be reluctant to fully disclose their contents. While HIPAA allowed patients easier access to their medical records starting in the late 1990s, patients still received them long after the fact and without interaction with their doctors.
However, the 21st Century Cures Act of 2016 pushed patient access to medical records into a whole new realm. Patients can not only access their records electronically and often within days of a medical visit, but their physician notes as well. Moreover, the JAMA Open study, authored by doctors and researchers from Harvard Medical School, Beth Israel Deaconess Medical Center, the University of Massachusetts, UCLA, the University of Washington and the Steele Institute for Health Innovation, concludes that the attitudes of the past may be fading away.
Aside from the nearly three-quarters of clinicians who said note sharing was a good idea, the same number, 74% of those who knew their notes were being read, said it was a good way to engage patients in their care. Altogether, 1,628 clinicians practicing at three different health systems, 58% of whom are doctors, were queried through a web-based survey conducted between May and August 2018.
There was some bias in terms of gender and age. Sixty-five percent of the respondents were women, and 61% were licensed in their profession in 2000 or after. And only 25% of those surveyed said they encouraged their patients to read their notes, while 18% said their patients mentioned the notes during subsequent visits.
Nevertheless, the sharing of notes has led 38% of clinicians to alter their note-writing habits. Of those, 58% said it was particularly to make the language easier to understand and less likely to cause offense in their patients. Female clinicians were more likely to make such changes than males, which the study's authors said may raise their already elevated risk for burnout. However, the authors also noted that clinicians seeing a high number of patients are less interested in note sharing altogether, suggesting they were too busy to adapt to the changing technology.
However, the study also concluded that older doctors were more comfortable with patients reading their notes than younger doctors, although no statistical breakdown was provided.
"We can only speculate on the reasons for this," the study's authors wrote. "More years in practice bring more established relationships, and perhaps greater appreciation for the importance of communication, along with greater confidence in listening and note-writing skills. Conversely, young physicians may feel more stress, competing priorities, or anxiety about building trust with their patients."