Will “Open Notes” Change EMR Design?

Today I read about a very interesting project focused on improving relationships between physicians and patients. I suspect the concept would make some doctors’ skin crawl — anytime you’re asked to give up over control of information, it smarts a bit — but I suspect we’re seeing a glimpse of the future.

The  OpenNotes project, which is being conducted at Beth Israel Deaconess Medical Center, Geisinger Health System and Seattle’s Harborview Medical Center, lets patients review the notes, e-mails and phone calls primary care doctors make after their medical appointment. Patients access the information via a secure Web interface.

In July 2010, researchers published baseline findings prior to the OpenNotes kickoff in the Annals of Internal Medicine. Since then, the project seems to have attracted a lot of interest, with more than 100 doctors and 20,000 patients participating.   It’s also gotten a lot of support from foundations;  the group has received grants from the Robert Wood Johnson Foundation Pioneer portfolio, the Drane Family Fund, the Koplow Family Foundation and the Katz Family Foundation.

Wondering how participants feel about this level of medical intimacy? Check out the OpenNotes site, where you’ll find a video  offering impressions from patients and doctors on how they feel about their level of communication.  As you’ll see, OpenNotes volunteer patients seem to enjoy having a closer relationship with their doctor, and more importantly, feel empowered to comment or even contradict the doctor if they see something that seems to be out of line.

“You can look at the comments that Bob writes down and sometimes you agree with him and sometimes you don’t,” says one patient. “Sometimes we clash on it, but then we work things out.” (Note the familiar title “Bob” the patient uses to address his doctor, which I doubt he would have otherwise.) Sounds like a better working relationship than I have with most of my providers!

Of course, there’s always questions as to whether approaches like these would work outside the confines of a grant-funded, academically-minded group of institutions and doctors.  Certainly that’s hard to tell. But it seems clear that at minimum, something worthwhile is going on here that might force vendors to think about patient facing data more deeply.  I’m impressed by what I see here and hope that we continue to learn from these efforts.

About the author

Anne Zieger

Anne Zieger

Anne Zieger is a healthcare journalist who has written about the industry for 30 years. Her work has appeared in all of the leading healthcare industry publications, and she's served as editor in chief of several healthcare B2B sites.


  • Will “Open Notes” change EMR design? No.

    There are three key phrases in the blog post: “secure web interface”, “volunteer patients”, and “grant-funded, academically-minded group of institutions and doctors”

    Secure web interface – really? Who’s liable if it isn’t?

    Volunteer patients – by definition, a group much more interested/curious than normal in tracking their health care. How many will quickly lose interest? What percentage of the overall patient population do they represent? 5%, 10%, 3%?

    Grant-funded, academically-minded group of institutions and doctors – i.e. those who will develop just about anything for a one shot infusion of cash (and job security). What’s the value of the project to the hundreds of thousands of doctors and hospitals who don’t get that cash? Will they begin demanding this technology from vendors?

    Great ideas in EMR design will occur when everyday patients and everyday doctors are able to find value in innovations offered by everyday EMR vendors. But right now, and for the foreseeable future, all those everyday folks are drowning in government regulation. They might fantasize about swimming to the tropical paradise visible just at the horizon, but right now they’re much more interested in keeping the sharks away.

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