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OpenNotes© Study Launches With More Than 100 Physicians, 25,000 Patients

National experiment to look at impact of greater physician-patient openness

BOSTON - With patients across the country voicing a growing desire for greater engagement in and control over their medical care, a new study involving patients in Boston, Pennsylvania and Seattle will examine the impact of adding a new layer of openness to a traditionally one-sided element of the doctor-patient relationship - the notes that doctors record during and after patients' visits.

Funded through a $1.4 million grant from the Robert Wood Johnson Foundation (RWJF) Pioneer Portfolio - which supports innovative ideas and projects that may lead to important breakthroughs in health and health care - the 12-month OpenNotes© Project will evaluate the impact on both patients and physicians of sharing, through online medical record portals, the comments and observations made by physicians after each patient encounter. Approximately 100 primary care physicians and 25,000 patients at Beth Israel Deaconess Medical Center in Boston, Geisinger Health System in Pennsylvania, and Harborview Medical Center in Seattle will participate in the 12-month trial.

"Patients remember precious little about what happens in the doctor's office," says Tom Delbanco, MD, a primary care physician at BIDMC and the Richard and Florence Koplow-James Tullis Professor of General Medicine and Primary Care at Harvard Medical School. "We expect OpenNotes© will improve patient recall, help patients take more responsibility for their care, and offer an opportunity for avoiding potential medical errors as patients and families monitor and think about their care in a much more active and knowledgeable way."

That premise is based in part on a recent study by Delbanco and Jan Walker, RN, MBA, Instructor in Medicine in the Division of General Medicine and Primary Care at BIDMC and Harvard Medical School. As reported in the Journal of General Internal Medicine (JGIM), Delbanco and Walker found that most consumers want full access to their medical records.

The study also found that consumers expect computers to play a major role in their future medical care, even substituting for face-to-face doctor visits.

"We learned that, for the most part, patients are very comfortable with the idea of computers playing a central role in their care," Walker says. In fact, patients said they not only want computers to bring them customized medical information, they fully expect that in the future they will be able to rely on electronic technology for many routine medical issues, she says.

"Doctors have strong differences of opinion about giving patients access to their notes. However, the debate is largely uninformed by evidence," says Stephen Downs, an assistant vice president at RWJF and member of the foundation's Pioneer Portfolio. "In the context of a physician's day-to-day work, opening up notes is a subtle change - but it could reposition notes to be for the patient instead of about the patient, which might have a powerful impact on the doctor-patient relationship and, in the long run, lead to better care."

To collect evidence, physicians and patients will fully share, through a simple one-step intervention, all encounter notes online. By contrasting the experience of trial participants with unenrolled physicians and patients, the researchers hope to measure the impact of OpenNotes through online surveys of both groups of doctors and patients.

"While this intervention potentially could disrupt the current flow of primary health care, it holds considerable potential to transform the doctor-patient relationship," says Delbanco. "By enabling patients to read their clinicians' notes, OpenNotes© may break down an important wall that currently separates patients from those who care for them. It may promote insight and shared decision-making by bringing closer together the unique expertise of the clinician and the unique understanding of himself or herself that each patient possesses."

About Beth Israel Deaconess Medical Center

Beth Israel Deaconess Medical Center is a patient care, teaching and research affiliate of Harvard Medical School, and consistently ranks among the top four in National Institutes of Health funding among independent hospitals nationwide. BIDMC is clinically affiliated with the Joslin Diabetes Center and is a research partner of Dana-Farber/Harvard Cancer Center. BIDMC is the official hospital of the Boston Red Sox. For more information, visit www.bidmc.org .

About the Robert Wood Johnson Foundation and the Pioneer Portfolio

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation's largest philanthropy devoted exclusively to improving the health and health care of all Americans, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, meaningful and timely change. Projects in the Pioneer Portfolio are future-oriented and look beyond conventional thinking to explore solutions at the cutting edge of health and health care. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. Visit www.rwjf.org/pioneer.