What is Open Notes?
Beginning April 5, 2021, a federal program addressing interoperability, information, blocking, and Office of the National Coordinator for Health IT will require that healthcare providers offer patients access to all the health information in their electronic medical records. It will include progress notes and tests authored by providers and a wide range of therapists.
Will there be any exceptions to Open Note content?
There may be a few exceptions – these include:
Preventing Harm Exception
This exception recognizes that the public interest in protecting patients and other persons against unreasonable risks of harm can justify practices that are likely to interfere with access, exchange, or use of EHI
This exception recognizes that if a provider is permitted to provide access, exchange, or use of EHI under a privacy law, then the provider should provide that access, exchange, or use. However, a provider should not be required to use or disclose EHI in a way that is prohibited under state or federal privacy laws.
This exception is intended to cover all legitimate security practices by providers, but does not prescribe a maximum level of security or dictate a one-size-fits-all approach.
This exception recognizes that legitimate practical challenges may limit a provider’s ability to comply with requests for access, exchange, or use of EHI. A provider may not have—and may be unable to obtain—the requisite technological capabilities, legal rights, or other means necessary to enable access, exchange, or use.
Health IT Performance Exception
This exception recognizes that for health IT to perform properly and efficiently, it must be maintained, and in some instances improved, which may require that health IT be taken offline temporarily. Providers should not be deterred from taking reasonable and necessary measures to make health IT temporarily unavailable or to degrade the health IT’s performance for the benefit of the overall performance of health IT.
Content and Manner Exception
This exception provides clarity and flexibility to providers concerning the required content (i.e., scope of EHI) of a provider’s response to a request to access, exchange, or use EHI and the manner in which the provider may fulfill the request. This exception supports innovation and competition by allowing providers to first attempt to reach and maintain market negotiated terms for the access, exchange, and, use of EHI.
This exception enables providers to charge fees related to the development of technologies and provision of services that enhance interoperability, while not protecting rent seeking, opportunistic fees, and exclusionary practices that interfere with access, exchange, or use of EHI.
This exception allows providers to protect the value of their innovations and charge reasonable royalties in order to earn returns on the investments they have made to develop, maintain, and update those innovations.
What is the benefit of Open Notes?
Patients who read their medical notes have expressed that they have an improved understanding of their medical condition, can recall their care plan more accurately, are better prepared for office visits, feel that they are in more control of their care, take their medications as prescribed more frequently and have an enhanced and stronger relationship with their providers. Patients often notice errors in their notes – this helps keep the medical record more accurate and improve patient safety. As expected, many patients may want to review information or literature about a specific diagnosis – they are very resourceful. However, patients report that they trust their providers more than the information generally available to the public. Another benefit of open and honest communication is reduced litigation as demonstrated in studies addressing medical error disclosure.
In addition, care partners and healthcare designees can benefit from open notes. As many patients rely on family members and others to coordinate appointments, tests, medications, and care plans, understanding the plan of care is vitally important. Transparent communication is a great way to diminish care provider stress. Many studies have demonstrated that patients want access to their notes and show that transparent communication increases reading rates. Research has also demonstrated that patients understand their note well. And in cases where they don’t understand everything in their note, this type of transparency and patient-provider communication is important to them. It build trust and brings the patient into more of a decision making role in respect to their own healthcare decisions
Are Organizations already doing this?
As of Fall, 2020, more than 250 healthcare organizations and systems around the country have chosen to provide open notes to more than 50 million patients. This usually requires the patient or healthcare proxy to register on the organizations health portal. Depending upon the healthcare system or provider office, the healthcare data may be made available immediately or there may be a delay for the provider to review certain tests and reports before releasing the reports for the patient to review.
If my patient reviews their office note, will they not call my office and request that something be changed?
Evidence thus far indicates that will not be the case. If an organization is successful in registering their patients on an information portal and educating patients on its features, requests for medical records may decrease after implementation. The more common items that patients are disputing are incorrect past medical history, past surgical history or past social history. They also may identify errors in medications, dosage, allergies, tests and procedures.
How will open notes impact my daily workflow?
None of the organizations that have implemented Open Notes have reported significant increases in visit time or e-mail traffic. Many organizations have actually seen a decrease in follow-up telephone call clarifying care plans or medication administration instructions. It may cause a provider to take a little bit more time assuring the accuracy and completeness of notes before posting to the portal. Experience to date shows that patients contacting their providers with comments or questions is uncommon.
To better help patients understand their notes, the following tips in documentation may be helpful: avoid abbreviations, avoid language that may seem judgmental, avoid copying and pasting, use plain language, complete and sign notes in a timely manner.