Your doctor's notes, with the click of a mouse

NEW YORK (Reuters Health) - After your next appointment, would you want to read everything your doctor wrote about you and your health?

Researchers are betting that you would - or at least that if you tried it, you would like it. They’re testing out a new system that lets patients see the doctor’s notes from their primary care visit via the internet.

“The whole idea here is to improve (and) expand the dialogue between patients and physicians,” Jan Walker, an instructor at Harvard Medical School and Beth Israel Deaconess Medical Center in Boston and one of the study’s lead researchers, told Reuters Health.

Beth Israel is one of three hospitals that is participating in the trial, called the OpenNotes project. At Geisinger Health System in Danville, Pennsylvania and Harborview Medical Center in Seattle as well as at Beth Israel, over 100 doctors and about 25,000 patients are trying out the system for a year.

Patients can look over the notes from a home computer and share them with family and friends if they choose. They can also access the information from a library or hospital computer if they don’t have one at home, which is the case for about half of the patients at Harborview, said Dr. Tom Delbanco, the other lead researcher on the study and a primary care physician at Beth Israel and professor at Harvard Medical School.

After a year of trying out the system, the researchers will ask patients and doctors about their experiences -- specifically, if patients would want to continue to have full access to their appointment notes online, and if doctors would want to give it to them.

The OpenNotes project got underway this summer, and the researchers explain the ideas behind the study in an article published in the latest issue of the Annals of Internal Medicine.

Patients are legally allowed to see their doctor’s notes, but many have to jump through hoops to get them, the authors note. Walker explained that some health care systems will charge patients money to get copies of their notes, while others only let them look over the notes when they’re sitting with a doctor.

But knowing all the information about your health care, Walker said, should be like knowing what’s in your bank account.

The researchers predict that making the information easily available will benefit both patients and doctors, and will allow patients to be more involved in their own care. And some patients agree.

“What’s happening is that access to information ... completely changes what’s possible for patients to contribute in a health care situation,” said Dave deBronkart, also known as “e-patient Dave,” a prominent blogger on patient involvement since his recovery from advanced kidney cancer and also one of the study’s participants.

deBronkart has already had his first doctor visit under the trial run, and said the new system made a difference right away. A couple weeks after the appointment, he said, he vaguely remembered something his doctor had said, and went online to check out the notes.

“It turns out it was significant because I had a crusty spot on my forehead, which he believes is a pre-cancerous skin lesion,” deBronkart told Reuters Health, and he’d forgotten to have it removed after the appointment.

Delbanco said that the cost of using this system would be minimal for hospitals that already have electronic records in place.

Some doctors told the research team that they were worried that patients might misinterpret or overreact to some of the information in their notes - and not all patients wanted to know everything their doctor wrote down.

But the researchers expect the benefits to outweigh any drawbacks, and think of patient access to doctors’ notes as one step on a road toward even more doctor-patient interaction, with more patients taking control of their health and health care.

“My own dream is that someday doctors and patients will generate records together,” Delbanco told Reuters Health, “that both will sign them and they will become in effect a contract between the patient and the doctor ... I think that can only help patients take better care of themselves.”

SOURCE: Annals of Internal Medicine, online July 19, 2010.