Categories: 'Opennotes

Is the ‘Open Notes’ Rule as Good in Practice as It Is in Theory?

Earlier this year, a federal rule that requires clinical information such as doctors’ notes and lab and imaging results to be made immediately available to patients took effect. A little more than 3 months out from implementation, there are mixed reviews as to how well the so-called ‘Open Notes’ rule is actually improving patient care.

Patient advocates and even many physicians have supported the concept of electronic health information in real-time, and say the rule is a first step toward dramatically improving the overall healthcare experience and can help lower the cost of care over time. But even proponents of the rule note that there are potential pitfalls, such as sensitive information reaching patients before their doctors have a chance to deliver and explain it.

Others say there’s bound to be a learning curve, and that feedback from patients and physicians needs to be documented and should be part of an ongoing conversation with federal officials. In their opinion, while the rule may be good in theory, it’s important to determine whether that also holds true in practice.

“Communication of information is essential for our profession and our patients,” Joseph Sellers, MD, president of the Medical Society of the State of New York, told MedPage Today. “Having ways to get information to patients as effectively and timely as possible is great, but we have to be careful about unintended consequences.”

Physicians’ Primary Concern

The criticism Sellers has heard from his medical colleagues centers around instances where patients get health information before physicians are able to help interpret it.

For instance, patients may receive pathology or imaging results electronically, prior to when their doctor is able to communicate with them via a phone call or office appointment.

A patient may find out bad news, and it may have been better for them to hear it first from their doctor, Sellers said. There may also be instances in which the complexity of test results makes them sound alarming, when they’re not. Or, there are times when physicians can help break down details that are difficult for the average patient to understand and digest.

“I think that having that relationship between the physician and the patient is so important. It provides reassurance, it provides confidence to patients in the healthcare system,” Sellers said.

Eric Schneider, MD, senior vice president for policy and research at The Commonwealth Fund, which supported the Open Notes rule, acknowledged the concern as a possible downside.

Patients may view information that’s frightening, Schneider said. That could include finding out about an abnormal mammogram or blood sugar reading that is higher than expected without any contextual information from a physician.

What’s in a Note

Another concern is that physicians’ notes from office visits are full of technical language or comments that may be interpreted by patients as being disparaging to them, Schneider said.

There’s a learning curve for physicians, he said, regarding how to articulate information in their notes in a way that doesn’t disparage patients, but is also accurate.

Though some physicians have expressed concerns over whether patient access to physician notes could lead doctors to censor the information they include, Caitlin Donovan, senior director of public relations at the National Patient Advocate Foundation, said the Open Notes rule could in fact have the opposite effect.

The rule “may have the added bonus of making [doctors’ notes] more accurate,” Donovan said.

During a recent project, for instance, the foundation found that patients reported their weight as one of the factors that made them reluctant to see a physician altogether, she said. That’s because, oftentimes, the first thing a provider may focus on is a patient’s appearance or weight

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