Tom Delbanco, MD; Jan Walker, RN, MBA; Jonathan D. Darer, MD, MPH; Joann G. Elmore, MD, MPH; Henry J. Feldman, MD; Suzanne G. Leveille, RN, PhD; James D. Ralston, MD, MPH; Stephen E. Ross, MD; Elisabeth Vodicka, BA; Valerie D. Weber, MD, MS
Acknowledgment: The authors thank the many doctors and patients who spoke with them as they planned the intervention and evaluation. They also thank Andrew and Jill Delbanco for their suggestions and critique.
Grant Support: By the Robert Wood Johnson Foundation's Pioneer Portfolio and the Drane Family Fund.
Potential Conflicts of Interest: None disclosed. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-0898.
Requests for Single Reprints: Tom Delbanco, MD, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215; e-mail, email@example.com.
Current Author Addresses: Drs. Delbanco, Feldman, and Leveille; Ms. Walker; and Ms. Vodicka: Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215.
Dr. Darer: Geisinger Health System, 100 North Academy Avenue, Danville, PA 17822-3055.
Dr. Elmore: University of Washington School of Medicine, Harborview Medical Center, 325 Ninth Avenue, Box 359780, Seattle, WA 98104-2499.
Dr. Ralston: Group Health Cooperative, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101-1448.
Dr. Ross: University of Colorado at Colorado Health Sciences Center, PO Box 6510, Aurora, CO 80045.
Dr. Weber: The Commonwealth Medical College, 501 Madison Avenue, 1st Floor, Scranton, PA 18510.
Author Contributions: Conception and design: T. Delbanco, J. Walker, J.D. Darer, H.J. Feldman, S.G. Leveille, S.E. Ross, V.D. Weber.
Analysis and interpretation of the data: T. Delbanco, S.G. Leveille.
Drafting of the article: T. Delbanco, J. Walker, J.G. Elmore, J.D. Ralston, S.E. Ross, E. Vodicka.
Critical revision of the article for important intellectual content: T. Delbanco, J. Walker, J.D. Darer, J.G. Elmore, H.J. Feldman, S.G. Leveille, J.D. Ralston, S.E. Ross, E. Vodicka, V.D. Weber.
Final approval of the article: T. Delbanco, J. Walker, J.D. Darer, J.G. Elmore, S.G. Leveille, J.D. Ralston, S.E. Ross, V.D. Weber.
Provision of study materials or patients: T. Delbanco, V.D. Weber.
Statistical expertise: S.G. Leveille.
Obtaining of funding: T. Delbanco, J. Walker, S.G. Leveille, J.D. Ralston.
Administrative, technical, or logistic support: T. Delbanco, H.J. Feldman, E. Vodicka, V.D. Weber.
Collection and assembly of data: T. Delbanco, H.J. Feldman.
Delbanco T, Walker J, Darer JD, Elmore JG, Feldman HJ, Leveille SG, et al. Open Notes: Doctors and Patients Signing On. Ann Intern Med. 2010;153:121-125. doi: 10.7326/0003-4819-153-2-201007200-00008
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Published: Ann Intern Med. 2010;153(2):121-125.
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Mark A. LaPorta
July 19, 2010
My notes have always described a contract.
In the past 15 years I often let my patients read what is written -- by me, or for instance the rules of their carrier or an x-ray result -- and sometimes I have them add to it and/or initial it.
So now we're adding a computer and making it more complicated.
I'm often amazed at what gets grants.
July 21, 2010
i think a patient should have access to the results of medical test as soon as possible and that doctors should be open and honest with patients.i received a copy of mri,mra,etc. in mail that should have went to my neurologist and i had no idea what they said,so i guess having access wouldn't matter much.
David A. Nardone
VA and OHSU Portland OR
Open Notes - Collaborative Model of Care --- Problem Lists
Sharing notes with our patients, as discussed by Delbanco et al, is an important component in implementing the collaborative model of health care. I have taken the liberty of sharing my "problem-list" as part of a summary I provide new patients after reviewing their charts and as part of an after-visit summary at the end of the appointment. To date, I have not received any negative feedback, including the sharing of a patient's mental health problems. The most frequent patient response is to clarify details and to correct any errors. I find this mutually advantageous for the reasons outlined in the article. I am confident the 'Open Note' electronic record initiative will gain wide acceptance.
R. Hal Baker
July 24, 2010
Nothing to fear but fear itself
In April 2007, the day the office in which I practice went live on our EHR, we realized that writing out patient instructions no longer made sense. For years, many of us had dictated notes in front of patients. So, at the noon meeting that day, we decided to just give patients a copy of their note at discharge, even though it contained a great deal more information than just instructions. Using voice recognition software, we dictated the assessment, orders, and any instructions before the patient left the room, and often completed the note before the patient arrived at checkout. The sky has not fallen. Patient comments have been uniformly positive. Calls have decreased, rather than risen, while the calls we have received have moved to "my brother in law has diabetes, not my brother," replacing "I forgot how he told me I was supposed to take the stomach pill." Patients have corrected errors in their record that would otherwise have gone uncorrected. Calls of confusion and panic have simply not materialized. In cross coverage of each other, we find each other's notes more understandable, perhaps because they were dictated with the lay patient reader in mind. In writing to patients, we write notes that are worth reading. I am glad to see this come under formal study, but my office already knows what the answer will be.
July 28, 2010
Open Notes: Doctors and Patients Signing On
Our profession began talking about sharing medical records with patients at least 37 (thirty-seven) years ago, when we said, "Concern that sharing information with patients may cause sustained psychological distress is probably unfounded."
A research study is a good way to change norms, and this group, through the incentive of grant funding, is changing the wiring of several electronic health record systems to try out a new way. That's significant in the path to changing norms. The other significant thing is communicating the results to the community in a respected communication vehicle. <P> I think this work adds to a lot of high impact efforts, including those of people like Regina Holliday , medial mural artist / activist , ( see my blog post about this : http://www.tedeytan.com/2010/07/25/5864 ) that will help physicians and patients learn how to make information transparent and use it to improve health
September 16, 2010
Collaberative Note Creation
For at least 10 years, my doctor has been using voice-recognition software to create his notes along with his patients during their visits. Since he creates them with me, I read along and can give input immediately, or clarify a question he may ask as he pauses his dictation. Since I have helped create this record I feel no need to ask for visibility to it through other means.
I have found this to be very beneficial for a variety of reasons, including immediate feedback, reviews of the last visit (which shows up on the screen as we start), and clarity of the translation that occurs from what I say to how it is recorded. He often pauses to ask if I would agree with the statements that were just recorded to the screen.
From a patient point of view, I highly recommend this practice, and I believe it both reduces the need for note visibility, but also the ease and expense of obtaining copies when needed.
Pulmonary/Critical Care, Education and Training, Healthcare Delivery and Policy, Prevention/Screening.
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