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TRANSCRIPT
Doctors & Patients on the Same Page!
Joann G. Elmore, MD, MPHProfessor of Medicine,
Adjunct Professor of Epidemiology
1. History of Medical Records
2. Prior Research on Medical Records and OpenNotes
3. Myths About OpenNotes and Electronic Medical
Records
4. Thinking About the Future….
OutlineDoctors and Patients on the Same Page
The Doctor, by Sir Luke Fildes (1887)History
Inside the Medical RecordWhat’s making my record so thick?
• Demographic information
• Clinic notes• Phone call notes• Medication List• Billing information• Allergies• Immunization record• Preventive care• Growth chart• Vital signs • Family medical history• Health problems• Lab test results• Radiology reports• Pathology reports• Notes from other
doctors
History
2. Prior Research on Medical Records
Electronic Health RecordsWV Slack et al NEJM 1966
“Neither the method of history taking and recording nor the
reliability and usefulness of the data collected has been studied as rigorously as the other tools of
clinical medicine…”
Prior Research on OpenNotes
Began with a 3-institution study in 2010Harborview Medical Center, Seattle WABeth Israel Deaconess, Boston MA Geisinger, Danville PA
Now, a national movement with >6 million patients and thousands of doctors, nurses, therapists, etc. sharing notes
Funded primarily by the Robert Wood Johnson Foundation
Prior Research on OpenNotesOpenNotes Pilot Study
Research Design Pre/post survey of patients & doctors12 months of sharing notes>100 volunteer doctors>19,000 patients
(Delbanco et al., Ann Intern Med, 2012)
Prior Research on OpenNotesOpenNotes Pilot Study
Study Questions
Does OpenNotes help patients become more engaged in their care?
Is OpenNotes the straw that breaks the doctor’s back?
After 1 year, will patients and doctors want to continue?
Prior Research on OpenNotesWhat did we learn from the patients?
They report important benefits
They are not scared stiffThey want the notes
They read the notes
They share the notes
Prior Research on OpenNotesThree out of four patients:
Felt more in control
Better recall
Improved understanding
Better prepared
Greater adherence to medicines
Prior Research on OpenNotesDoctors’ Concerns about OpenNotes Impact on Workflow
Doctors’ Concerns Pre-Study Post-Study
More time addressing patient questions outside of visits
42% 3%
More time writing, editing notes 39% 11%
Prior Research on OpenNotesThe Bottom Line After 1 Year
99% of patients wanted to continue accessing their visit notes online.
85% of patients said availability of OpenNotes would affect their future choice of providers.
Not one doctor asked to stop.
3. Myths about OpenNotes and Electronic Medical Records
Myth Patients are not allowed to read their medical record.
Myth Patients are not allowed to read their medical record.
www.uwmedicineecare.org
BUSTED!
Myth Access is available to all patients, regardless of age.
Myth Access is available to all patients, regardless of age. BUSTED!
All doctors like electronic health records and are ready to share them with patients.
Myth
All doctors like electronic health records and are ready to share them with patients.
Myth
“Should patients have access to their entire medical record ‒ including MD notes, any audio recordings, etc…?”
Over 2,300 physicians responded:34% ‒ Yes, always49% ‒ Only on a case-by-case basis17% ‒ No, never
(Dan Munro, Forbes.com June 2015)
BUSTED!
Myth Your doctor has easy access to all of your records from multiple clinics.
Myth Your doctor has easy access to all of your records from multiple clinics. BUSTED!
Different electronic health record systems often are not compatible
Clinicians do not always automatically receive test results from your other providers
Clinicians rely on patients to help
Electronic health records are masterpieces.Myth
Myth Electronic Health Records are masterpieces.
Address sensitive concerns directly Discuss what you write and write what you discuss
Typos and Transcription Errors “History of sick as hell disease” (sickle cell disease)
Example words and terms:- “Disheveled” - “Patient refused treatment” - “The patient comes in full peacock finery”- Acronyms such as “SOB,” “BS” - “Morbid obesity”- “Semi-athletic”
BUSTED!
Myth The medical record will be easy to understand.
Myth The medical record will be easy to understand.
“56 yo AA male is SOB today, but denies CP or LE edema. Cardiac exam obscured by loud BS. Had TTE 2 wks ago with LVEF 15% and nl valves. F/u with cards for likely cath and to discuss AICD. Continue diuretic blitzkrieg and check creatinine as my fear is that he’s getting pruned out.”
BUSTED!
Patient name: John Doe
Harborview #: 1234567
Date of Visit: 03/05/14
LLL: 2+ MGD OUC/S: w/q OUK: 1+ MCE, tr stromal edema, 3-4+ guttae OUAC: d/q OUI: r/r OUL: 2+ NSC OU, 1+ PSC OSAV: Shafer negative Vit: PVD OD, syneresis OSON: 0.4 C/D OUMac: large drusen OU, GA OD, + CNVM c SRH OSV: unremarkableRet: LD temporally OU, no RT or RD
Myth The medical record will be easy to understand.
An Example Eye Clinic Note
BUSTED!
Myth The medical record will be easy to understand.BUSTED!
1 2 3 4 5 6 7 8 9 100%5%
10%15%20%
25%30%35%40%45%
Non-ophthalmologist Physicians' Understanding
of Eye Clinic Notes(n = 59)
Physician self-rating of level of understanding
Perc
ent
of p
hysi
cian
s
No Understand-ing
Perfect Under-standing
Myth All abnormal test results are cause for alarm.
Myth All abnormal test results are cause for alarm.
Example Lab in Patient PortalBUSTED!
Myth All abnormal test results are cause for alarm.BUSTED!
“INCIDENTALOMAS”
Whole-body CT screening – findings detected in 37%Furtado et al., Radiology 2005
MRI Lumbar Spine – findings detected in 8.4% Park et al., AJR 2011
Myth It’s easy to find reliable information on the web & TV.
Myth It’s easy to find reliable information on the web & TV. BUSTED!
Any Evidence Dr. Oz Show The DoctorsEvidence Agrees 46% 62%
Evidence Disagreed 15% 14%
No Evidence to Support 39% 24%
Examination of medical TV show contentKorowynk et al BMJ 2014Information not balanced:
Magnitude of benefit (<20%)Potential harms mentioned (<10%)Cost (<15%)Conflict of interest (<1%)
4. Thinking about the Future
Thinking about the FuturePatient Safety
Thinking about the FutureMedications Adherence
Thinking about the FutureCaregivers
Thinking about the FutureDoctor Patient Relationship
Doctors and Patients on the Same Page!
THANK YOU TO OUR GENEROUS SUPPORTERS