WIHI - A Podcast from the Institute for Healthcare Improvement
Health & Fitness:Medicine
Date: November 1, 2012
Featuring:
Some changes in medicine are easier to contemplate than others. For a long time the notion that patients should be able to view what doctors write about them, following a visit, was unthinkable. It was a kind of “patient don’t ask, doctor don’t tell” policy. However, the growth of electronic health records, increased pressure for transparency, and the need to improve communication and understanding between patients and providers in every way possible are all tugging at information once considered off limits.
Despite the fear that “physician notes” have a tendency to be brief, even glib, and might unintentionally insult or alarm the reader, some health systems, like Dartmouth Hitchcock, have been successfully offering patients easier access to these notes, along with the entire electronic health record, for several years. [See the December 2009 WIHI: OpenNotes and the Electronic Medical Record.]
Still many more health systems have been on the fence, waiting for evidence that there’s value in doing so — and that the benefits outweigh the risks. Now that evidence seems to have arrived, and this WIHI digs into the experience of more than 13,000 patients and 100 primary care doctors who were part of a pilot study.
The findings appear in the October 2, 2012, issue of the Annals of Internal Medicine, reporting on a one-year experiment with what have come to be called “open notes” at three major health care organizations: Beth Israel Deaconess Medical Center (BIDMC) in Massachusetts, Geisinger Health System in Pennsylvania, and Harborview Medical Center in the state of Washington.
WIHI host Madge Kaplan welcomes lead author of the study, Dr. Tom Delbanco, one of the key innovators behind OpenNotes and their trial use at BIDMC, and two clinicians who helped lead the pilots at Geisinger and Harborview. By making notes accessible to patients in their own practices, both these clinicians came to better understand shared decision making and the ways in which transparency, rather than offend, increases trust. Michael Meltsner shares what mattered to him when he faced serious illness. A distinguished law professor, Meltsner’s “A Patient’s View of OpenNotes” also appears in Annals, and captures the brave new world of patient expectations and the need to level the playing field.
WIHI: Reports from the Frontlines of Effective Crisis Management
WIHI: Primary Care's (New) Pressures and Possibilities
WIHI: Health Care’s Newest Improvers: Patient and Family Advisors
WIHI: The Newest Innovator on the Block: Center for Medicare and Medicaid Innovation
WIHI: A Legible Prescription for Health Care
WIHI: Alert to Change: New Models for Residency Work Hours
WIHI: The Power of Specialty Care – and the Necessity to Use It Wisely
WIHI: The Patient Activist
WIHI: Finding the Will to Bend the Cost Curve
WIHI: Nursing’s New Roadmap: Education, the Workforce, and Health Care Quality
WIHI: The Leaders Needed for the Changes Health Care Needs
WIHI: The Power to Detect and Reduce Harm: IHI’s Global Trigger Tool and Adverse Events in the US
WIHI: Reducing Readmissions, Restoring Revenues: Making Good Care Count
WIHI: The Buzz about Medical Training: It’s (Slowly) Changing
WIHI: Leaders Never Stop Learning
WIHI: Against All Odds: Maternal Survival in Ghana and the US
WIHI: Unprofessional Behavior Not Permitted Here
WIHI: The Image of Better (Radiation) Imaging Practices
WIHI: Learning by Data and by Doing: Low-Cost, High-Quality Health Care in America
WIHI: Coaching’s the Thing for Primary Care Practice
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