Transcript OpenNotes - UW Medicine

Doctors & Patients on the Same Page!
Joann G. Elmore, MD, MPH
Professor of Medicine,
Adjunct Professor of Epidemiology
Outline
Doctors and Patients on the Same Page
1.
History of Medical Records
2.
Prior Research on Medical Records and OpenNotes
3.
Myths About OpenNotes and Electronic Medical Records
4.
Thinking About the Future….
History
The Doctor, by Sir Luke Fildes (1887)
History
Inside the Medical Record
What’s making my record so thick?
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Demographic information
Clinic notes
Phone call notes
Medication List
Billing information
Allergies
Immunization record
Preventive care
Growth chart
Vital signs
Family medical history
Health problems
Lab test results
Radiology reports
Pathology reports
Notes from other doctors
2. Prior Research on Medical Records
Electronic Health Records
WV Slack et al NEJM 1966
“Neither the method of history
taking and recording nor the
reliability and usefulness of the
data collected has been studied
as rigorously as the other tools of
clinical medicine…”
Prior Research on OpenNotes
 Began with a 3-institution study in 2010
Harborview Medical Center, Seattle WA
Beth Israel Deaconess, Boston MA
Geisinger, Danville PA
 Now, a national movement with >6 million patients
and thousands of doctors, nurses, therapists, etc.
sharing notes
Funded primarily by the Robert Wood Johnson Foundation
Prior Research on OpenNotes
OpenNotes Pilot Study
Research Design
Pre/post survey of patients & doctors
12 months of sharing notes
>100 volunteer doctors
>19,000 patients
(Delbanco et al., Ann Intern Med, 2012)
Prior Research on OpenNotes
OpenNotes Pilot Study
Study Questions
Does OpenNotes help patients become more engaged
in their care?
Is OpenNotes the straw that breaks the doctor’s back?
After 1 year, will patients and doctors want to continue?
Prior Research on OpenNotes
What did we learn from the patients?
They read the notes
Prior Research on OpenNotes
Three out of four patients:
 Felt more in control
 Better recall
 Improved understanding
 Better prepared
 Greater adherence to medicines
Prior Research on OpenNotes
Doctors’ Concerns about OpenNotes Impact on Workflow
Doctors’ Concerns
Pre-Study
Post-Study
More time addressing
patient questions
outside of visits
42%
3%
More time writing,
editing notes
39%
11%
Prior Research on OpenNotes
The Bottom Line After 1 Year
 99% of patients wanted to
continue accessing their visit
notes online.
 85% of patients said availability
of OpenNotes would affect their
future choice of providers.
 Not one doctor asked to stop.
3. Myths about OpenNotes and
Electronic Medical Records
Myth
Patients are not allowed to read their medical
record.
Myth
Patients are not allowed to read their medical
record.
www.uwmedicineecare.org
Myth
Access is available to all patients, regardless
of age.
Myth
Access is available to all patients, regardless
of age.
Myth
All doctors like electronic health records and are
ready to share them with patients.
Myth
All doctors like electronic health records and are
ready to share them with patients.
“Should patients have access to their entire medical record ‒
including MD notes, any audio recordings, etc…?”
Over 2,300 physicians responded:
34% ‒ Yes, always
49% ‒ Only on a case-by-case basis
17% ‒ No, never
(Dan Munro, Forbes.com June 2015)
Myth
Your doctor has easy access to all of your
records from multiple clinics.
Myth
Your doctor has easy access to all of your
records from multiple clinics.
Different electronic health record systems often
are not compatible
Clinicians do not always automatically receive test
results from your other providers
Clinicians rely on patients to help
Myth
Electronic health records are masterpieces.
Myth
Electronic Health Records are masterpieces.
Address sensitive concerns directly
Discuss what you write and write what you discuss
Typos and Transcription Errors
“History of sick as hell disease” (sickle cell disease)
Example words and terms:
- “Disheveled”
- “Patient refused treatment”
- “The patient comes in full peacock finery”
- Acronyms such as “SOB,” “BS”
- “Morbid obesity”
- “Semi-athletic”
Myth
The medical record will be easy to understand.
Myth
The medical record will be easy to understand.
“56 yo AA male is SOB today, but denies CP or
LE edema. Cardiac exam obscured by loud BS.
Had TTE 2 wks ago with LVEF 15% and nl
valves. F/u with cards for likely cath and to
discuss AICD. Continue diuretic blitzkrieg and
check creatinine as my fear is that he’s getting
pruned out.”
Myth
The medical record will be easy to understand.
Patient name: John Doe
Harborview #: 1234567
Date of Visit:
03/05/14
An Example Eye
Clinic Note
LLL:
C/S:
K:
AC:
I:
L:
AV:
2+ MGD OU
w/q OU
1+ MCE, tr stromal edema, 3-4+ guttae OU
d/q OU
r/r OU
2+ NSC OU, 1+ PSC OS
Shafer negative
Vit:
ON:
Mac:
V:
Ret:
PVD OD, syneresis OS
0.4 C/D OU
large drusen OU, GA OD, + CNVM c SRH OS
unremarkable
LD temporally OU, no RT or RD
The medical record will be easy to understand.
Myth
Non-ophthalmologist Physicians'
Understanding of Eye Clinic Notes
(n = 59)
45%
40%
Percent of physicians
35%
30%
25%
20%
15%
10%
5%
0%
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2
No Understanding
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4
5
6
7
Physician self-rating of level of understanding
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9
10
Perfect Understanding
Myth
All abnormal test results are cause for alarm.
Myth
All abnormal test results are cause for alarm.
Example Lab in Patient Portal
Myth
All abnormal test results are cause for alarm.
“INCIDENTALOMAS”
Whole-body CT screening – findings detected in 37%
Furtado et al., Radiology 2005
MRI Lumbar Spine – findings detected in 8.4%
Park et al., AJR 2011
Myth
It’s easy to find reliable information on the web
& TV.
Myth
It’s easy to find reliable information on the web
& TV.
Examination of medical TV show content
Korowynk et al BMJ 2014
Information not balanced:
Magnitude of benefit (<20%)
Potential harms mentioned (<10%)
Cost (<15%)
Conflict of interest (<1%)
Any Evidence
Dr. Oz Show
The Doctors
Evidence Agrees
46%
62%
Evidence Disagreed
15%
14%
No Evidence to Support
39%
24%
4. Thinking about the Future
Thinking about the Future
Patient Safety
Thinking about the Future
Medications Adherence
Thinking about the Future
Caregivers
Thinking about the Future
Doctor Patient Relationship
Doctors and Patients on the Same Page!
www.myopennotes.org
[email protected]
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