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.
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WIHI: Accelerating Improvement: The Enduring Value of Collaboratives
WIHI: How Health Care Organizations Can Create Equity in the Community
WIHI: Relationships Count: Community Health Workers and Team-Based Care
WIHI: Getting Right Care, Right!
WIHI: What Students in the Health Professions Can Do for You... and Improvement
WIHI: Saving Lives by Design: Lessons for All from Ghana's Project Fives Alive!
WIHI: The Echo Effect of Project ECHO's Access to Specialty Care
WIHI: The IHI Triple Aim: Lessons from the First Seven Years
WIHI: Disability Competent Care
WIHI: Now What? Best Practices for Newly Diagnosed Cancer Patients
WIHI: Leaning In: Oregon's Coordinated Care Organizations
WIHI: Reducing Risks and Defects with Help from the Front Lines
WIHI: All Hands on Deck to Reduce C. Difficile
WIHI: The Managers and Management We Need to Improve Care
WIHI: Bundles and Buy-In for Value-Based Care
WIHI: Topping the Charts in Pediatrics and Adverse Events Reporting
WIHI: The Ups and Downs of Health Care Costs and Reform
WIHI: When Everyone Knows Your Name: Identifying Patients with Complex Needs
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