Bringing OpenNotes to Geisinger

Recently, over 520 of our doctors began sharing their office visit notes with patients.

All primary care doctors and general pediatricians, and selected physicians within pediatric subspecialties, dermatology, endocrinology, pulmonology, nephrology, rheumatology, cardiology, cardiothoracic surgery, vascular surgery, neurosurgery, and women’s health—including obstetrics and gynecology and gynecologic oncology—are participating in OpenNotes.

That means tens of thousands of our patients will have access to the notes doctors write about them. After each visit to their doctor, patients will get an email inviting them to read their doctors’ notes via the secure MyGeisinger online patient portal.

Giving patients easy access to their doctors’ notes can be a powerful tool for getting patients involved in their own care. It can help them remember more of what was discussed during their appointments and better understand their conditions and follow care instructions.

How did we get here?

Geisinger was one of three study sites that participated in a one-year trial of OpenNotes, supported by the Robert Wood Johnson Foundation. Over 12 months, 24 primary care physicians from Geisinger, along with 81 doctors from Beth Israel Deaconess Medical Center in Boston and Harborview Medical Center in Seattle, shared their notes with patients.

Making the physician notes available online really seemed to make a difference to patients.  At Geisinger, 82% of our patients viewed their notes. What’s more, patients reported feeling more in control of their care and being more likely to take their medications as prescribed when doctors shared their notes.

It’s rare for a single study in medicine to change practice so quickly, but the evidence about giving patients access to their notes is so compelling that most providers and departments at Geisinger have agreed to adopt OpenNotes as their new standard of care. Some departments are still tentative, willing to test this new openness with patients with just a few physicians.  We’re not expanding OpenNotes into psychiatry or pain medicine. And while pediatricians are participating, at this time we have excluded adolescents and young adults between ages 12-17 in order to safeguard their privacy.

We’re about two-thirds of the way there in terms of eligible providers willing to share their notes. However, the momentum is very strong and we will anticipate even greater participation over the next 12 months.  We are also actively working to bring in learners, and hope to make notes written by residents and fellows available to patients later this year.

Expanding OpenNotes

We anticipate continued interest from patients and for OpenNotes to expand quickly to other Geisinger doctors; our goal is to get 80% of eligible doctors on board by July of 2014.

As we move ahead, we hope others will join us in adopting OpenNotes. It appears to be a safe yet effective way of engaging patients in their care. We believe that OpenNotes represents an important milestone in achieving transparency with our patients and, if we believe what our patients say, OpenNotes will become standard practice in health care across the country.

Jon Darer is chief innovation officer, Geisinger Health System.

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  • Emily Gibson

    We have been using McKesson’s Practice Partner secure patient portal Webview to do this for over two years and there are clear benefits for patients being able to review their chart notes and correspond with their provider electronically. This is a sea change in the provider/patient relationship that is long overdue.

  • Shirie Leng

    With a few reservations, I think this is a good thing. I am all for patient engagement and this certainly fits that bill. As a physician at BI in Boston, I have talked with physicians who have used OpenNotes and they have had positive experiences with it. The only thing that worries me is data in the record that either can’t be interpreted by a lay person, will be mistakenly interpreted as “bad” or will be mis-interpreted. So far it seems this worry is largely misplaced. Any data on this?

    • Elvish

      Do you think we need data to know that it is a bad idea ?

      • Guest

        Why are you afraid of letting your patients see what you write about them?

        • Elvish

          1. There is no benefit in it to patients nor to physicians.

          2. Patients are not fit to read SOAP notes; however, they can have access to modified lists of labs, studies, diagnoses, meds but not the actual thing we write.

          • EmilyAnon

            “(patients) can have access to modified lists of labs, studies, diagnoses……”

            Modified as in dumbing down, as in altered as in deception. Is that even legal?

          • Elvish

            That would be rude and insensitive, I wouldn`t use the term “dumbing down”.

            Patients will not benefit from knowing the rationale behind using or not using ACEIs for their “Heart failure”.

            They won`t benefit from knowing the details of the Echocardiography report, it will only cause problem.

            Patients will compare notes with other patients and Dr.Google and this will lead to more problems.

          • EmilyAnon

            One of the reasons I request copies of labs, radiology, operating reports, etc. is to have them immediately available when I see one of my other doctors who will want to be aware of any changes in my medical history. My doctors have always been appreciative of this habit. However that attempt at efficiency would be lost if the appointment would have to be rescheduled waiting for the unexpurgated versions to arrive.

    • Suzi Q 38

      I haven’t seen any data, but I think it is a good idea.
      I will admit that I “Goggle” the words or conditions that I do not understand. It turns out that some of my physicians don’t pick up on all the technicalities, either.
      For example, my neuroradiologist saw something on my cervical MRI that led him to believe that I not only had spinal stenosis of unknown origin, but I may have a rare condition called OPLL (ossification of the posterior longitudinal ligament?). Anyway, I picked my neurosurgeon, not only because he was good, but he had written a few papers on OPLL.
      When I asked him how he would approach the rest of my surgery if he opened me up and discovered this, he just said….”I am not going to change my course of surgery at all,” LOL.
      I felt like getting yet another opinion, but at some point in time, you just have to quit reading all of that $#it ( my own medical reports) and trust.

  • Elvish

    WebMD, Google and Wikipedia PLUS open access to medical records and doctors` notes is a disastrous combination.

    Moreover, you give patients access to doctors-in training notes ?!!!
    Who thought that this is a good idea ?

    Another scam, filled with “good intentions” and “patients empowering” flavours.

    • Margalit Gur-Arie

      I don’t think this will make any significant difference on a population level, but I am curious: why do you think this is or can be disastrous?

      • Elvish

        Patients are not qualified to analyse and interpret medical information and data.

        1. I had back pain and the doctor did not suspect xxx disease and he/she should`ve ordered an MRI to rule it out, according to Wikipedia, or Mrs. Johnson`s case.

        2. WebMD says that we check xxxx test when we suspect yyyy disease, I didn`t see it on my SOAP note, why ?

        Besides, notes written by residents and fellows are deficient, most of the time, hence they are going through residency and fellowship training.
        Do you think patients will appreciate this fact ? Most of them will not.

        This is just another “Made in the U.S.” scam !

        • Guest

          All patients are retards !

        • Suzi Q 38

          Patients are not qualified to analyse and interpret medical information and data.

          I beg to differ.
          After my anterior cervical disscection, they took another MRI 4 months after my surgery.

          In spite of the fact that I felt better, the MRI told a far different story.
          I was concerned, so I forwarded the MRI report to a neurosurgeon family friend.

          He calmed me down, saying that although the report was not very promising, it was more how I felt vs. what the report looked like.

          I tried not to think about it until I spoke with my neurosurgeon. He told me that I didn’t have MS, plain and simple, and when I told him about my concerns, he just laughed.
          He told me that I shouldn’t be reading medical stuff when I am not trained to interpret the findings. I get it.

          I relayed what he said to my two MS specialists, who was perplexed at what the huge light spot was on my cervical spine.
          It was still there, plain as day. Unlike other patients, I did not want the label of MS nor did I want the MS drug treatment if I didn’t have the test results that supported that diagnosis.
          One doctor said: ” Well, did you ask your neurosurgeon what this huge light spot is on your cervical spine?”

          The MS specialists finally ruled “suspected TM (transverse myelitis), but I got the feeling that they were just giving their best guess since my brain scans, LP, and various blood tests were negative.

          • Elvish

            What you have described is unfortunate, but it does not mean that patients can interpret medical data or doctors` notes.
            I`m sorry for what happened to you but again, we are playing with fire here.

          • Suzi Q 38

            Medical data is difficult for us to understand, but doctor’s notes, written in English, are not for me.

            Why would you think we were “playing with fire?”

          • Elvish

            Part of medical training is learning how to speak to other doctors and how to document properly.
            Why on earth would we let patients read junior residents` notes or even medical students` notes ?
            Scroll up and read my earlier comments.

          • Suzi Q 38

            Thanks for your explanation.
            I have not read medical student’s notes.
            The neurology fellow answers most of my questions via email, anyway. The MS neurologist is semi retired so he will answer sometimes.

  • azmd

    Engaging a patient in his or her medical care is a critically important aspect treatment. If making doctor’s notes available to patients to review improves patient engagement, it is obviously a positive thing.

    Just out of curiosity, I would like to know if the above study in any way tracked the extent (if any) to which physicians ended up spending extra time per patient due to having to respond to patient questions about information they saw in their notes?

  • azmd

    Interestingly, I see also from that abstract, that up to 21% of doctors reported taking longer to write their notes and up to 36% of doctors reported having to change their documentation. So, in fact there is some evidence that Open Notes slowed providers down.

    Also interesting to note that about 60% of patients believe that they should be able to add their own notes to the chart and 1 in 3 patients believes they should be allowed to “approve” the note, with 85-95% of doctors disagreeing.

    Somehow, not quite the rosy picture of patients being productively and efficiently engaged with their physicians that I might have hoped for.

    • Guest

      “up to 21% of doctors reported taking longer to write their notes and up to 36% of doctors reported having to change their documentation”

      Maybe the new era of openness and transparency forced upon them has caused them to take a little more care with things. That’s not necessarily a bad thing.

      • azmd

        Unless you are one of the millions of patients who feels like your doctor doesn’t spend enough time with you…where do you think that extra documentation time comes from? It comes out of the patient encounter.

    • Suzi Q 38

      I think that taking longer to write the notes is bound to happen.
      The doctors know that more eyes may be on their notes.
      I had all of my notes pulled to see what the doctors had to say about my condition and subsequent treatment for the last two years.

      Most visits were accurate, but others were not.
      I would have loved to add my view of what had transpired during out visit.

  • maryhirzel

    Yes, why in the world not share them with patients? You’re going to be sharing them with marketers, employers, cops, the FBI, HHS, DHS, every insurance company on the globe, marketers, hackers and gossip columnists……….

    • Tim

      Don’t forget the IRS.

      • maryhirzel

        Oh! My goodness, yes! ESPECIALLY the IRS………

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