Intended for healthcare professionals

Analysis Spotlight: Patient Centred Care

US experience with doctors and patients sharing clinical notes

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.g7785 (Published 10 February 2015) Cite this as: BMJ 2015;350:g7785
  1. Jan Walker, assistant professor of medicine1,
  2. Michael Meltsner, professor of law 2,
  3. Tom Delbanco, professor of medicine1
  1. 1Division of General Medicine and Primary Care, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
  2. 2Northeastern University School of Law, Boston, USA
  1. Correspondence to: J Walker jwalker1{at}bidmc.harvard.edu

The move to offer patients online access to their clinicians’ notes is accelerating and holds promise of supporting more truly collaborative relationships between patients and clinicians, say Jan Walker, Michael Meltsner, and Tom Delbanco

For decades clinicians have experimented with making medical records available to patients.1 2 3 4 5 6 Now electronic medical records and associated secure internet portals provide patients the opportunity to view test results, medications, and other selected parts of the medical record on line.7 But few patients are offered full access to their records; clinicians’ notes are rarely visible. After a demonstration project showed the acceptability of OpenNotes (www.myopennotes.org) in the US,8 several prominent healthcare providers decided to make clinicians’ notes available to patients online before further formal evaluation. We describe the OpenNotes movement in the US and how sharing notes with patients is spreading. We also underline the case for research to assess the long term effect of sharing notes and the potential to foster improved and truly collaborative care.

US OpenNotes initiative

The movement to share clinicians’ notes with patients in the US was spurred by the findings of a demonstration and evaluation project that included 105 volunteering primary care doctors working at three large and disparate institutions and 19 000 of their patients who were registered to use their patient portal (box 1).8 Most patients in the study chose to read their notes and reported benefits from doing so, with only a slight effect on primary care doctors’ workload. After 12 months, 99% of patients wanted to continue to have access to their notes online and none of the doctors decided to stop the practice.

Box 1: OpenNotes study8

12 month study in primary care practices at three sites
  • Beth Israel Deaconess Medical Center, a large teaching hospital offering primary care in Boston, and affiliated suburban practices

  • Geisinger Health System, an integrated system with …

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