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OpenNotes and Your Patient

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OpenNotes and Your Patient

OpenNotes and Your Patient
Christina DuVernay

Date: 08/24/2017

Howard Levy is a man with a mission. As the lead physician champion for OpenNotes, he wants to spread the word about the benefits of giving patients easy access to their clinicians’ notes.

“Clearly, patients like it, and there’s evidence that being able to refer back to their doctors' notes improves medication adherence,” he says. “What’s more, surveys show that the availability of OpenNotes influences patients’ choice of physician.”

A feature in Epic that allows the physician's note from a medical visit to be read by the patient via MyChart, OpenNotes will be implemented at Johns Hopkins Medicine for all ambulatory specialties by January 2018, he says, with the exception of psychiatry, substance abuse, general pediatrics, adolescent medicine, and obstetrics. Inpatient notes, operative notes and documentation from video visits or phone calls are not covered. Levy points out that patients have always had access to their medical records: “OpenNotes just lowers the bar,

And he observes that the benefits to the patient — the ability to jog memory, verify that the doctor has everything right, and so forth — outweigh the burden on the clinician, which is less than many think.

“Some of my colleagues have shared with me their concerns that patients will ask a lot more questions. Our own internal research has shown no increase in call volume or MyChart messages after OpenNotes was turned on,” he says.

But Are There Downsides?

Some physicians question whether transparency is the best policy when exam notes involve medical terms  like “obesity that have negative connotations to the layperson. In most cases, sharing the notes and diagnoses are fine, although it is possible for physicians to opt not to share a diagnosis or the note. “If the clinician judges that sharing would cause more harm than good, then it is appropriate to withhold certain notes,” Levy says.

But in his own practice, Levy finds that sharing notes makes him more open with patients and facilitates sensitive conversations with them. “I’ll say to a patient: ‘Your BMI is over 40. The medical term for this is morbidly obese.’ And I’ll ask the patient how he feels about it. No patient likes it, but not one has said, ‘That’s wrong; take it out.’ I find this to be a less loaded way to say, ‘You have a weight problem. What are we going to do about it?’”