by Jill Clendening
When DeAnna Crawford needs a reminder about why her physician recommended a recent medication change, she just logs in to My Health at Vanderbilt (MHAV), the Vanderbilt University Medical Center online patient portal, and reviews the notes her doctor took during the appointment.
In October, patients who receive treatment at three VUMC clinics were given full access to their clinicians’ notes in their electronic medical records as part of an OpenNotes pilot, and Crawford is one of more than 26,000 patients who can now review those notes.
OpenNotes is an international effort launched nearly a decade ago to provide patients complete and straightforward access to their medical providers’ clinical notes, a part of their medical record that is already legally the patient’s but has often been time-consuming or difficult to obtain. Currently, more than 40 million patients in the United States have been provided OpenNotes access to their clinical notes, including all Department of Veterans Affairs (VA) medical facilities and half of the nation’s top 50 cancer centers.
When the program is fully implemented, VUMC will be one of the first health care systems in Tennessee to offer OpenNotes, joining VA system facilities, Methodist Le Bonheur Healthcare in Memphis, and Murfreesboro Medical Clinic, a multispecialty clinic in Rutherford County. The Vanderbilt Patient and Family Advisory Council has been a strong advocate for the addition of OpenNotes at VUMC, and this initiative joins many other VUMC efforts that support increased transparency in health care.
“Patients have full right of access to their medical provider’s notes already under HIPAA (the Health Insurance Portability and Accountability Act of 1996), but often to get access to those notes they have to jump through a number of hurdles and possibly pay fees,” said Trent Rosenbloom, MD, MPH, associate professor of Biomedical Informatics, Medicine and Pediatrics and director of MHAV. “OpenNotes makes it much, much easier. Patients will be able to access these notes on their phones, just like everything else they do now.”
Following the eight-week pilot, results will be assessed and further steps will be determined before all VUMC patients who have a My Health at Vanderbilt account — to date that’s nearly 480,000 English-speaking users — are given online access to clinicians’ notes, said Rosenbloom.
OpenNotes has been researched extensively throughout the world since its launch, and published studies indicate that having access to the entire provider note, regardless of its potential jargon and abbreviations, is more beneficial to patients than having no notes at all to refer to, Rosenbloom said. Study findings also suggest that shared clinician notes improve communication, medication compliance, adherence to treatment plans, patient safety and patient-provider relationships, as well as help patients to become more actively involved with their health and health care.
The clinics participating in the pilot include the Vanderbilt Inflammatory Bowel Disease (IBD) Center, the Pediatric Hematology and Oncology Clinic and the Liver Transplant Clinic. These sites were chosen in large part because their patients are typically very engaged in their care and interact regularly with their care teams, said Paul Sternberg Jr., MD, Chief Medical Officer and Chief Patient Experience Officer.
While he certainly expects patients to benefit from the addition, Sternberg, who is also a practicing ophthalmologist, said OpenNotes might lead to clinicians’ notes that are better understood by all.
“It might require us to do things a little differently,” he said. “I will tell you that the internists have a terrible time reading ophthalmologists’ notes because we have so many abbreviations. For example, an internist might read SLE as ‘systemic lupus erythematosus’ when, for an ophthalmologist, it’s actually ‘slit-lamp exam.’ There’s a big difference. They would love for us to create a note that is more user-friendly.”
More than two decades ago, Crawford was diagnosed with Crohn’s disease, a chronic inflammatory bowel disease (IBD) that requires close monitoring and a strict medication regimen to manage. She feels the close interaction she has with her medical team, which has already been enhanced by My Health at Vanderbilt, will be further strengthened by the addition of OpenNotes.
“To me, knowledge is power,” she said. “I’ve always been one of those patients who is very proactive because, in my opinion, no one knows my body like I know my body and no one knows more about what I need than me. Having these notes available to read is a great reinforcement of what I just discussed with my doctor during a visit, and it helps clarify that we’re on the same page.”
Her physician, David Schwartz, MD, who also directs the Inflammatory Bowel Disease Center, agreed.
“We have a medical home-type approach for our IBD patients, so when we have a new patient, they see not only their medical provider, but also a social worker, psychologist, dietitian and sometimes even a pharmacist during a three- to four-hour visit,” he said. “Most of our patients are on complex immunosuppressive regimens and biologics. That can be information overload. For individuals to be able to just go back and review the notes to see what everyone said during that visit is invaluable. I think overall it’s going to be a very positive thing.”
