Executive Summary
Some physicians fear that giving patients complete online access to medical records, as does the Open Notes system at Beth Israel Deaconess Medical Center, increases liability risks. However, a recent study showed that patients are highly satisfied when given online access.
Patients report increased adherence to medications.
Patients can alert providers to errors in the record.
A well-documented informed consent discussion accessible online could provide a defense to claims alleging that a patient wasn’t informed.
"If this had been available years ago I would have had my breast cancer diagnosed earlier. A previous doctor wrote in my chart and marked the exact area but never informed me. This potentially could save lives."
This was one patient’s response to the Open Notes system, an internally developed system used at Boston-based Beth Israel Deaconess Medical Center’s. Open Notes not only allows patients to look at their electronic medical record, but also to make corrections by writing to the physician in the record.
"Suits often follow misunderstandings, especially when patients and families feel they have been left out of the communications loop," says Jan Walker, RN, MBA, an assistant professor of medicine at Harvard Medical School in Boston.
In a 2012 study of the OpenNotes system, of the 5,391 patients who opened at least one note and completed a survey, 60-78% of patients across the three participating sites who were taking medications reported increased adherence.1
Patients are able to review their record whenever they wish, which gives them the opportunity to spot errors in the record. "They call them to the attention of their providers for correction and maybe save errors down the road," says Walker, the study’s co-first author. A patient might notice an allergy isn’t recorded in the chart, for example, or that a recommended diagnostic test was never ordered.
Patients highly satisfied
Making the record more readily available through online access is likely to have minimal negative impact or have a beneficial impact on liability risk, says Bryan Lee, MD, JD, assistant professor in University of Washington’s Department of Ophthalmology.
For example, a well-documented informed consent discussion that a patient can easily review online could prevent a claim alleging that the patient did not understand the risk, benefits, and alternatives to a procedure. If it’s documented well online, the patient has the ability to review it multiple times and to gain a better understanding of the risks and benefits of the procedure before the surgery. "If there were a negative outcome, a patient can more easily go back to the chart after the surgery and confirm that this is something that was discussed, potentially decreasing the likelihood of hiring counsel and pursuing a possible malpractice suit," says Lee.
Still, some doctors fear that patients looking through their records will uncover mistakes, leading to more lawsuits.
"The Open Notes study has shown that patients are highly satisfied when given online access to their clinical notes," says Lee. "And we know from other research that patients who like their providers and experience greater transparency are actually less likely to sue." (See related story, p. 128, on liability risks involving online access to records.)
- Delbanco T, Walker J, Bell SK, et al. Inviting patients to read their doctors’ notes: A quasi-experimental study and a look ahead. Ann Intern Med 2012; 157(7):461-470.
- Sharona Hoffman, JD, Co-Director, Law-Medicine Center, Case Western Reserve University School of Law, Cleveland, OH. Phone: (216) 368-3860. Email: [email protected].
- Bryan Lee, MD, JD, Assistant Professor, Department of Ophthalmology, University of Washington, Seattle. Phone: (206) 685-1916. Fax: (206) 685-7055. Email: [email protected].
- Daniel O’Connell, PhD, Seattle. Phone: (206) 282-1007. Email: [email protected].
- Jan Walker, RN, MBA, Assistant Professor of Medicine, Harvard Medical School, Boston. Email: [email protected].
