Thoughts on Patient Access to Health Information?

The Doctor, by Sir Luke Fildes (1891)

Image via Wikipedia

Hello everyone:  In a post on open.source.com, Lori Mehen asks “Will reading your doctor’s notes make you healthier?”

You probably remember the Seinfeld episode she recounts in her article:

‘In an old Seinfeld episode, Elaine visits her doctor  and manages to sneak a peek at the physician’s notes. She sees she’s been labeled “difficult.” The doctor grabs the notes from her and after a confrontation, jots down more notes. Later, Elaine convinces Kramer to try to get access to her chart, but he walks out empty-handed only to report, “they’ve now created a chart on me.”‘

She goes on to talk about a study named OpenNotes which asks:

‘”The OpenNotes project aims to improve communication and transparency between doctors and patients,” says Dr. Tom Delbanco, the lead investigator of the study. “We have one simple research question: After a year, will the patients and doctors still want to continue sharing notes?“‘

My question to all of you out there in the HIM space is – what do you think? You have transcribed and coded and QA’d and abstracted countless physician notes.

You are also patients and consumers of healthcare. It is one thing for engineers and developers of software to speculate – and even a subgroup of physicians who want the transparency between them and their patients – but I’d like to hear from those of you who listen to and read physician documentation day in and day out.

Do you think the average physician documents in a way that can be understood by the patient? Do you think he or she should have to? Will physicians be inclined to leave information out of documentation that might be worrisome to a patient? Is there information a doctor might be unwilling to present for patient viewing because of legal concerns?

How will this impact documentation in support of ICD-10 and quality measures which require a higher level of specificity in the documentation? Does the need for a record to be understood by a patient conflict with the need for a higher level of documentation?

I think everyone would agree that better communication between physicians and patients would be beneficial to the patient. Is open access to physician documentation the answer? Are there pieces of the HIM workflow that can help to create a patient-facing summary? Um – hint – MTs? Or would that be frowned up?

Would love to hear your thoughts!

Lynn

M*Modal

References:

Mehen, L. Retrieved February 4, 2011from http://opensource.com/life/11/2/will-reading-your-doctors-notes-make-you-healthier

OpenNotes. Retrieved February 4, 2011 from http://www.myopennotes.org/

One Response

  1. Nice Post. The one exception area I’ve heard doctors mention is mental health – some clinics have policies on sharing this info with patients. Bad news for patients with paranoia, I suppose.

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