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Sharing notes with patients improves medication comprehension

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More is needed to promote clinical transparency

The study by Delbanco et al. demonstrates the value in sharing clinical notes with patients and builds upon previous findings that such transparency can enhance patient understanding and compliance, according to David Blumenthal, MD, and Melinda K. Abrams, MS, of the Commonwealth Fund.

Dr. David Blumenthal is president of the Commonwealth Fund.

Dr. David Blumenthal

While the study highlights the importance of openness among medical practices, more work is needed to ensure transparency can take place on a broader level, Dr. Blumenthal and Ms. Abrams wrote in an editorial accompanying the Delbanco study. These efforts should include more medical education about information sharing at the undergraduate, graduate, and postgraduate levels as well as stronger privacy protocols at practices and health care organizations, the authors wrote.

Health care providers also need to work with technology companies to create consumer-facing applications that enable patients to better understand their health information and use the data to take better care of themselves, according to the editorial.

“Assisting patients in the choice and use of these applications will often fall to clinicians,” the authors wrote. “Some applications may let patients participate in amending their own records. The OpenNotes team, with support from the Commonwealth Fund, is developing an approach called OurNotes that enables patients to modify their physician’s visit notes – in effect, to cogenerate such documents.”

The authors noted that more work remains in the gathering health information from nontraditional sources like social media, wearables, and mobile devices and integrating these mediums into the formal clinical record. Additionally, disparities in the ability of different patient populations to consume health care data needs to be addressed.

The authors concluded by saying that, ready or not, health care professionals are living in an age of mass transparency. The challenge for physicians is to make the best of such shared health information by using it as a tool for health improvement.

Dr. Blumenthal is President of the Commonwealth Fund and Ms. Abrams is vice president for the Commonwealth Fund. They made these comments in an editorial that accompanied the Delbanco et al. study in the Annals of Internal Medicine (2019 May 28. doi: 10.7326/M19-1366). The authors disclosed no conflicts of interest.


A study suggests that allowing patients to read their physician’s notes may help many of them better manage and adhere to their medications.

Lead authors Tom Delbanco, MD, and Jan Walker, RN, MBA, of Harvard University and Beth Israel Deaconess Medical Center, both in Boston, conducted an online survey in 2017 of 19,411 patients in three separate health systems who participated in the OpenNotes pilot, an initiative that provided patients access to online clinical notes about their care. Eligible survey participants were 18 years or older and had logged into their respective patient portal at least once in the last 12 months and had an ambulatory visit note available.

Of the patients surveyed, a combined 14% of patients from Beth Israel Deaconess Medical Center and Geisinger Health reported that reading their notes made them more likely to take their medications as prescribed, while 86% reported no change, according to the study published in the Annals of Internal Medicine. At the University of Washington, Seattle, 33% of patients rated notes as “extremely important” in assisting with medication regimens. (The wording and response categories used by the University of Washington were not the same as those used by the other sites.)

The majority of patients at all three sites reported that note reading helped them understand why a medication was prescribed, answered their questions, and made them feel more comfortable with and in control of their medications, according to the study.

Of patients with a primary language other than English, 75% reported that reading their clinical notes helped them understand why a medication was prescribed, compared with 64% of patients who spoke English as their primary language. Of patients with high school or less education, 74% reported that reading their notes helped answer their questions about their medications, compared with 53% of college graduates.

The researchers also found that about 8 out of 10 survey participants reported looking at their medication list on the patient portal at least once. Of those patients who checked the portal for their medications, 18% said that the list was not accurate, and 85% wanted to submit corrections online.

The authors concluded that although note sharing means a substantial change in the culture of medicine, the practice of inviting patients to review clinicians’ notes online is spreading rapidly.

“Reading visit notes may be important for sustained improvements in the use of medications over time in ambulatory care,” they noted.

SOURCE: Delbanco et. al. Ann Intern Med. 2019 May 28. doi: 0.7326/M18-3197

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