OpenNotes co-director says doctors will soon write notes for patients instead of themselves

By Aditi Pai
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Doctors will eventually begin to write their notes more for patients than they will for their own memories or for other doctors, according to OpenNotes Co-director Tom Delbanco who spoke at the Pop Health Forum in Boston this week. Delbanco discussed some of the impacts OpenNotes could have on both the patient and their provider.

OpenNotes, which launched in 2010 as a pilot program to give patients access to their doctors' notes, has opened access to between 8 million and 10 million patients, according to Delbanco. 

“I think it will be a patient-focused, centric note more and more over time,” Delbanco said. “We will stop using acronyms — you guys use acronyms all the time. When we say SOB, the patient thinks we are talking about something different. I think you will slowly see the notes morphing and then of course we will adjust them for literacy and for language and we’ll define terms with push of a cursor.”

Delbanco added that eventually patients will stop using the EHR and the patient portal. Instead they’ll carry their notes on their watch, iPhone, or other gadget and maybe even share their notes on social media.

“The doctor-patient relationship and the nurse patient relationship is confidential,” Delbanco said. “If Danny talked to me about one of his patients when I have no particular reason to hear about that patient, Danny will be fired from the Beth Israel Deaconess Medical Center because he’s breaching confidentiality. On the other hand, whether it’s private is now up to the patient. Danny’s patient can download the note, put it on Facebook, and say ‘Hey what do you think of what this guy is saying? Does he know what the hell he is talking about?’ And crowdsource an answer — ‘Should I do this, should I do that?’”

OpenNotes was first piloted in 2010 at Beth Israel Deaconess Medical Center, Geisinger Health System, and Harborview Medical Center. Now, a number of other providers have adopted the practice, including University of Texas MD Anderson Cancer Center, The Department of Veterans Affairs, Kaiser Permanente Northwest, Nationwide Children’s Hospital, University of Colorado Health, Ochsner Health System, and DukeHealth.

In August 2015, after five years of collecting data on OpenNotes, Beth Israel published a study that found not only is the arrangement beneficial to patients, but also to doctors -- and to the accuracy and quality of the notes.

The study was led by Dr. Sigall Bell, an assistant professor of medicine at Harvard Medical School. In particular, she said, patients helped doctors catch medication errors and remember next steps. Having access to notes improved patients' adherence to treatment plans, improved care coordination, and helped some patients to get diagnosed more quickly.

This week, Delbanco also pointed out that although a majority of patients enjoyed having access to their notes, and some even chose to share notes with family members, there will be times where patients should have the option of keeping notes confidential from others in their care circle and providers should have the option to keep notes sealed from patients.

“This is not simple, this is not one flavor fits all,” Delbanco said. “You may want your daughter to read about your sore knees. You may not want her to read about your sex life or your mental health problems. You may want to be reminded once a month or right after a note. You want to be able to exhibit your preferences and so do doctors. Doctors want to be able to hide notes from certain patients and they should have that right — what they do, by the way, is they do much better when they know they can hide them and then don’t hide them. But it certainly decreases resistance when you’re implementing it to know they can be hidden.”