With 5 years of data, BIDMC finds OpenNotes helps doctors catch errors

By Jonah Comstock
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Dr. Sigal Bell Dr. Sigal Bell

Beth Israel Deaconess Medical Center in Boston now has five years of data on what happens when patients have access to their doctor's notes. And from that data, it appears that not only is the arrangement beneficial to patients, but also to doctors -- and to the accuracy and quality of the notes.

Researchers at the hospital, led by Dr. Sigall Bell, an assistant professor of medicine at Harvard Medical School, recently published a study in looking back at five years of notes, encompassing 100 doctors and more than 2,000 patients.

"In many common safety categories, it appears that having the patient’s or an informal caregiver’s eyes on clinical notes can help ensure care is safer," Bell said in a statement. "Doctors review hundreds or thousands of charts; patients review one: their own. OpenNotes may have a unique role in connecting patients and clinicians in the space between visits.”

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.

“These are all examples of patients who used the notes to engage in their own health care and to play active roles in making their care better,” Bell added. “The message that we are getting from many patients is that they want to participate in their care. And while the responsibility for patient safety still rests primarily with health care organizations, this research shows us what’s possible when we make space at the table for patients.”

Originally funded by a Robert Wood Johnson Foundation grant, the OpenNotes initiative began in 2010. The movement to make clinicians’ notes available to patients began to generate headlines in 2012 when researchers at Beth Israel 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 .

The OpenNotes movement has spread to the Cleveland Clinic, the Mayo Clinic, Geisinger Health System, and nine hospitals in the Northwest that adopted it en masse in April 2014, to name just a few. More than 5 million patients nationwide now have access to their notes. Meanwhile Beth Israel has continued to push the limits of note-sharing: last July the hospital made the controversial move of expanding the practice to mental health specialists, and in January they launched a new pilot that would allow patients to not only read but contribute to their notes.

Currently Beth Israel researchers are working on a two-year study funded by CRICO, a hospital insurance provider. The study will "examine the impact of note sharing on patient safety, medical errors and communication with the goal of further developing and refining an online reporting tool for patients to provide feedback on their notes," according to Beth Israel.

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