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. 2017 Apr;26(4):262-270.
doi: 10.1136/bmjqs-2015-004697. Epub 2016 May 18.

When doctors share visit notes with patients: a study of patient and doctor perceptions of documentation errors, safety opportunities and the patient-doctor relationship

Sigall K Bell  1 , Roanne Mejilla  1 , Melissa Anselmo  1 , Jonathan D Darer  2 , Joann G Elmore  3 , Suzanne Leveille  1   4 , Long Ngo  1 , James D Ralston  5 , Tom Delbanco  1 , Jan Walker  1
Affiliations

When doctors share visit notes with patients: a study of patient and doctor perceptions of documentation errors, safety opportunities and the patient-doctor relationship

Sigall K Bell et al. BMJ Qual Saf. 2017 Apr.

Abstract

Background: Patient advocates and safety experts encourage adoption of transparent health records, but sceptics worry that shared notes may offend patients, erode trust or promote defensive medicine. As electronic health records disseminate, such disparate views fuel policy debates about risks and benefits of sharing visit notes with patients through portals.

Methods: Presurveys and postsurveys from 99 volunteer doctors at three US sites who participated in OpenNotes and postsurveys from 4592 patients who read at least one note and submitted a survey.

Results: Patients read notes to be better informed and because they were curious; about a third read them to check accuracy. In total, 7% (331) of patients reported contacting their doctor's office about their note. Of these, 29% perceived an error, and 85% were satisfied with its resolution. Nearly all patients reported feeling better (37%) or the same (62%) about their doctor. Patients who were older (>63), male, non-white, had fair/poor self-reported health or had less formal education were more likely to report feeling better about their doctor. Among doctors, 26% anticipated documentation errors, and 44% thought patients would disagree with notes. After a year, 53% believed patient satisfaction increased, and 51% thought patients trusted them more. None reported ordering more tests or referrals.

Conclusions: Despite concerns about errors, offending language or defensive practice, transparent notes overall did not harm the patient-doctor relationship. Rather, doctors and patients perceived relational benefits. Traditionally more vulnerable populations-non-white, those with poorer self-reported health and those with fewer years of formal education-may be particularly likely to feel better about their doctor after reading their notes. Further informing debate about OpenNotes, the findings suggest transparent records may improve patient satisfaction, trust and safety.

Keywords: Patient safety; Safety culture; Teamwork.

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Conflict of interest statement

Competing interests None declared.

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References

    1. Greene J, Hibbard JH, Sacks R, et al. When patient activation levels change, health outcomes and costs change, too. Health Aff 2015;34:431–7. - PubMed
    1. Greene J, Hibbard JH, Sacks R, et al. When seeing the same physician, highly activated patients have better care experiences than less activated patients. Health Aff 2013;32:1299–305. - PubMed
    1. Hibbard JH, Greene J, Shi Y, et al. Taking the long view: how well do patient activation scores predict outcomes four years later? Med Care Res Rev 2015;72:324–37. - PubMed
    1. NHS England. Health and social care leaders set out plans to transform people’s health and improve services using technology. 13 November 2014. http://www.england.nhs.uk/2014/11/13/leaders-transform/ (accessed 30 Jul 2015). - PubMed
    1. Australian Government Office of the Australian Information Commissioner. E-Health records. http://www.oaic.gov.au/privacy/privacy-act/e-health-records (accessed 30 Jul 2015).

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