New Initiative Gives Patients Access to Clinician Notes

The Vancouver Clinic intends to roll out the new program, known as Open Notes, within the next six weeks

When Regina Holliday’s husband was dying of kidney cancer, she was told she would have to pay 73 cents a page and wait weeks for her husband’s medical records. At about the same time, Holliday -- now a national advocate for patients' rights -- had asked Stephen King for an early edition of his then-latest novel so her husband, a big fan, could read it before he died.

“I could get a galley edition of a new book by an A-list author before medical records in a hospital where my husband was admitted,” she told a packed audience at the We Can Do Better Conference last week.

Open Notes is a national initiative to give patients easy access to clinician notes. It enables patients to “read and ruminate…when they want to do it, similar to vote by mail,” said Dr. John Santa, director of the Health Ratings Center at Consumer Reports.

Robert Unitan said his Northwest Permanente medical group began sending “you’ve got notes” emails to patients April 8. “It was a non-event. No screaming clinicians or patents.” Clinicians received training on excluding teens and mental health issues, while avoiding some jargon, such as abbreviating “shortness of breath” as SOB.

Tim Burdick with OCHIN, said his organization is nudging one provider at a time to use Open Notes. “It’s still a somewhat controversial topic. Organizations like Kaiser saying ‘this is the standard of care helps.”

John Greves of The Vancouver Clinic intends to roll out Open Notes in the next six weeks. “We have a number of providers who are uneasy with it but we have to get Americans involved with their health. This is really about communication and delivery, not just about the physical reading of the note but about how the patient and physician interact.”

When seeking medical care, patients are also being empowered to ask five questions through the national awareness and education campaign Choosing Wisely, conducted locally by the Oregon Medical Association in partnership with Consumer Reports.

  1. Do I Really Need This?

  2. What are the Risks or Downsides?

  3. Is there a Simpler, Safer Option?

  4. What Happens if I Do Nothing?

  5. What’s the Cost?

It’s not uncommon for patients to seek the wrong care, said Katrina Kahl, director of communications for the Oregon Health Care Quality Corporation. Low back pain, for example, is best treated with heat and over-the-counter pain medication.

“It gets better in five to six weeks,” Kahl said. “There’s no need for imaging unless it’s very specific pain. Imaging leads to care you don’t need.” In Oregon, 26 percent of patients with simple back pain get pills, while 16 percent get narcotics.

Opiate demand “didn’t just happen, Santa said. Multiple pharmaceutical companies have been telling patients they need these drugs for years. This demand was created by industry.”

Another common misperception exists around price. “We believe if it’s more expensive, it must be better. In healthcare, that isn’t necessarily true,” Kahl said.

Not all Portland hospitals perform well on all procedures, Santa said. Take heart bypass surgery. In 2012, Kaiser Sunnyside was the best performer and the only hospital that kept its three-star status in 2013. OHSU was a one-star because it had a lower volume of those procedures and was less able to avoid complications than hospitals that do a high volume.

When evaluating quality and price, Santa suggested people review transparency vendors such as Cast Light (castlighthealth.com) and Health Care Blue Book (healthcarebluebook.com). “You can’t have a market when the buyer doesn’t know the price.”

Will high-deductible plans or co-pays of 40 percent for chronic conditions prompt more people to shop more critically? Probably, says Kahl, but maybe not right away -- or even until it’s too late. “It’s hard to engage people until they need care or get stuck with a bill they didn’t expect.”

Jan can be reached at [email protected].

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