OpenNotes: Hospitalists' challenge and opportunity

Authors

  • Henry J. Feldman MD,

    Corresponding author
    1. Division of Clinical Informatics, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
    2. Division of General Internal Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
    • Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Department of Medicine, Massachusetts
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  • Janice Walker RN, MBA,

    1. Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Department of Medicine, Massachusetts
    2. Division of General Internal Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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  • Joseph Li MD,

    1. Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Department of Medicine, Massachusetts
    2. Division of General Internal Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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  • Tom Delbanco MD

    1. Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Department of Medicine, Massachusetts
    2. Division of General Internal Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Address for correspondence and reprint requests: Henry Feldman, MD, Division of Clinical Informatics, Beth Israel Deaconess Medical Center, 1330 Beacon St., Suite 400, Brookline, MA 02446; Telephone: 617-278-8151; Fax: 617-278-8181; E-mail: hfeldman@bidmc.harvard.edu

Abstract

At a time of societal fascination both with transparency and the explosion of health information technologies, a growing number of hospitals are offering, or will soon offer patients and their family instantaneous access to their doctors' and nurses' notes. What will this new opportunity for patient engagement mean for the hospitalist? Today, state and federal government regulations either encourage or require healthcare providers to grant patients access to their clinical information. But despite the rules embedded in the federal Health Insurance Portability and Accountability Act (HIPAA), patients often face time-consuming obstacles in their quest for access, and many providers view compliance as a burden. We suggest an alternative view: Over time, we anticipate that inviting patients to review their medical record will reduce risk, increase knowledge, foster active engagement, and help them take more control of their care. The OpenNotes trial provides clues as to how such practice will affect both patients and providers (1, 2). We anticipate that transparent records will stimulate hospitalists, PCPs, and other caregivers to improve communication throughout the patient's hospital stay. OpenNotes offers a special opportunity for improving the patient experience after leaving the hospital as well. Open notes will be viewed by many as a disruptive change, and the best strategy for adapting will be to move proactively to create policies that establish clear guidelines, for which the authors offer some suggestions. Journal of Hospital Medicine 2013;8:414–417. © 2013 Society of Hospital Medicine

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