Most Clinicians Who Share Medical Record Notes With Patients Find It Helpful - Survey

At healthcare systems that give patients access to medical record notes, three in four clinicians think it's a good idea and can be useful and engaging for patients, a web-based survey suggests.

Researchers invited 6,064 physicians, advanced practice nurses, registered nurses, physician assistants, and therapists at three health systems in Boston, Seattle, and rural Pennsylvania to complete an online survey about their views and experiences sharing medical record notes. A total of 1,626 clinicians (27%) responded.

"Our study was conducted at three healthcare organizations where patients have had access to virtually all of their outpatient notes for at least 4 years, so these are experienced clinicians," said Catherine DesRoches of Beth Israel Deaconess Medical Center and Harvard Medical School in Boston.

"Our findings suggest that when notes are shared across outpatient care settings, patients report substantial benefits and clinicians experience few changes to the workflow," DesRoches said by email.

A decade ago, the idea of letting patients see medical record notes was still a fringe idea, DesRoches and colleagues write in JAMA Network Open. The 21st Century Cures Act of 2016, however, requires that patients be given electronic access to information in their medical records, and recent regulations have expanded this to include more detailed information, they note.

As of the beginning of 2020, more than 44 million patients at more than 200 US health care organizations had access to their notes through online patient portals, the study team writes.

The majority of survey respondents were physicians (58%), female (65%), licensed to practice in 2000 or later (61%), and spent fewer than 40 hours per week in direct patient care (71%).

Most viewed open notes positively, with 74% agreeing that sharing notes with patients is a good idea. Among 1,314 clinicians who were aware that patients were reading their notes, 74% agreed that open notes were useful for engaging patients. In all, 798 clinicians (61%) would recommend the practice to colleagues, the survey found.

A total of 292 physicians (37%) reported spending more time on documentation, and many reported specific changes in the way they write their notes, the most frequent of which related to use of language that could be perceived as critical of the patient (58%).

Most physicians (78%) favored being able to determine readily that their notes had been read by their patients.

One limitation of the study is the low response rate to the survey.

Clinicians who responded may be more in favor of open notes than those who chose not to respond, said Dean Sittig, a professor of biomedical informatics at the University of Texas Health Science Center at Houston.

"If this were true, then the results of the survey could be reversed, since close to 75% of clinicians did not respond," Sittig, who wasn't involved in the study, said by email. "If these non-responders were more likely to hate open notes, we will never know from this survey."

It wasn’t clear whether giving patients access to medical record notes required clinicians to spend more time on these records or prompted them to change how they recorded information, the study team notes.

One potential harm of note sharing is that the information could be misinterpreted or confusing to patients if the note is written using complex terminology, said Ann Kutney-Lee, an adjunct associate professor at the University of Pennsylvania School of Nursing in Philadelphia.

"The current study is encouraging in that it shows that providers have adjusted the language they use in notes to make them more accessible to patients," Kutney-Lee, who wasn't involved in the study, said by email. "In addition to using different terms, the potential for confusion can also be reduced by not including new information in the note that was not discussed during the visit."

Reading notes may also help reinforce and enhance what patients learn during checkups, said Julia Adler-Milstein, director of the Center for Clinical Informatics & Improvement Research, at the University of California, San Francisco.

"Because of their narrative structure, they tell more of the 'clinical story' and it can be helpful to a patient to see how their clinician tells that story of what's going on with them and what the clinician thinks is happening from a diagnostic or treatment perspective as well as the plan moving forward," Adler-Milstein, who wasn't involved in the study, said by email. "They may understand better why their clinician recommended a particular course of care or get a better sense for where there is clinical uncertainty."

—Lisa Rapaport

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