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: Highly Reliable Hospitals: The Work Ahead
WIHI: The Patient Will See You Now: New Technology for New Collaborations
WIHI: The Social Imperative to Demonstrate That Better Care = Lower Costs
WIHI: Have You Had "The Conversation"? Helping Loved Ones Discuss End-of-Life Preferences
WIHI: Removing Barriers to Care with Medical-Legal Partnerships
WIHI: Heard at the Forum: New Ideas and Learning from IHI's 23rd Annual National Forum
WIHI: Night Talks and Nocturnists: New Interventions for the Hospital at Night
WIHI: Health Literacy: New Skills for Health Professionals
WIHI: Organizing for Health: A Story from South Carolina
WIHI: Safety Net Hospitals: Untold Stories of Quality Transformation
WIHI: Family Caregiving, Caregivers, and Compassion
WIHI: Managing Medication Shortage: Best Practices for a Crisis
WIHI: Always Events: Raising Expectations for Patient Experience
WIHI: Payment Reform As We Speak
WIHI: Improving Health Care: The Global View
WIHI: New Models for Patients with Multiple Health and Social Needs
WIHI: Integrity On and Off the Page: A Discussion with JAMA’s (Departing) Editor-in-Chief
WIHI: Leading Across the Continuum
WIHI: Palliative Care = Quality Care
WIHI: The Power to Detect and Improve: Revisiting the IHI Global Trigger Tool and Adverse Events
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