Beth Israel pilot to let patients add notes to medical records

By Aditi Pai
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Female Doctor with TabletBoston's Beth Israel Deaconess Medical Center received a $450,000 grant from The Commonwealth Fund this week to develop a program called OurNotes that allows patients to contribute to their medical records. The program is an extension of the well-known OpenNotes initiative and will include collaboration with a handful of other providers across the country.

"This is really building for the future," BIDMC Principal Investigator Jan Walker said in a statement. "We envision the potential capability of OurNotes to range from allowing patients to, for example, add a list of topics or questions they'd like to cover during an upcoming visit, creating efficiency in that visit, to inviting patient to review and sign off on notes after a visit as way to ensure that patients and clinicians are on the same page."

The original OpenNotes is an initiative that aims to provide patients with access to their clinician's notes. The movement to make clinicians' notes available to patients began to generate headlines in 2012 when researchers at BIDMC found that patients with access to clinician notes were more engaged and saw better outcomes. The results from the year-long study of more than 13,500 primary care patients and 100 physicians were published in Annals of Internal Medicine

BIDMC's grant from The Commonwealth Fund will support work at four other sites as well. Two of the sites, Geisinger Health System in Danville, PA and Harborview Medical Center in Seattle, WA were in the original OpenNotes study, but Group Health Cooperative and Mosaic Life Care will also participate.

The participating sites will focus initially on primary care and speak with clinicians to learn what information they want to receive from patients. They will also ask patients what information they want to share via their medical records. After this initial phase, each site will develop its own prototype and use it to run pilot tests.

In July 2014, BIDMC launched a different OpenNotes pilot in which 700 mental health patients received access to their therapists’ notes on their laptop or smartphone. At the time, lead author and assistant professor of psychiatry at Harvard Medical School, Dr Michael Kahn added: “Nationally, the momentum is shifting in favor of transparency in the medical record, but understandable caution and controversy remain when it comes to mental health notes."

Some concerns that existed, according to Kahn, included how a patient would react to reading a diagnosis of his personality disorder and what a patient with schizophrenia would feel when a therapist wrote that her “firm convictions” are delusional. Still, according to the researchers, allowing patients to read therapist notes might help them address their mental health issues actively and reduce the stigma that they feel around mental health.

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