Who Is Sharing Notes?
At the University of Texas MD Anderson Cancer Center, patients and their referring physicians have been given access to their electronic medical records—including their doctors’ notes—since May 2009 via a secure Web-based portal.
Despite little promotion of the site to patients, to date more than 40,000 individuals have viewed their records over 605,000 times. In that same period, more than 1300 referring physicians accessed the records of the patients they referred to us over 28,000 times. Currently, 84% of our active patients have obtained access to their electronic records.
Patients have become avid readers of their notes—their 2 most common requests are for a correction of something recorded incorrectly and for a simple method of translating medical terminology within the record. Our referring physicians are happy with the tool, and we are planning to cease mailing records to referring physicians.
Beth Israel Deaconess Medical Center (BIDMC) in Boston, Massachusetts is a teaching hospital of Harvard Medical School with 113 hospital-based and community primary care providers, serving approximately 90,000 patients. Its patient portal PatientSite was launched in 1999. About 50,000 Beth Israel Deaconess patients and 1,000 clinicians use PatientSite to gain access to medical records, e-mail doctors, make appointments, renew prescriptions and request referrals.
As part of the OpenNotes study, a select number of primary care doctors elected to share their notes with patients through PatientSite. 39 primary care physicians and 10,000 patients participated in the OpenNotes study. BIDMC plans to expand OpenNotes to other clinicians and patients in the future, allowing patients to read on PatientSite the visit notes written by doctors, nurses, physician assistants, physical therapists, or other members of the health care team. The intervention is designed so that doctors can “monitor” a note, thereby blocking patient access to sensitive information if necessary.
Geisinger Health System is an integrated health services organization widely recognized for its innovative use of the electronic health record, and the development of innovative care models such as ProvenHealth Navigator® and ProvenCare®. As the nation’s largest rural health services organization, Geisinger serves more than 2.6 million residents throughout 44 counties in central and northeastern Pennsylvania. The physician-led system is comprised of more than 19,500 employees, including a 1,000-member multi-specialty group practice, six hospital campuses, two research centers and a 448,000-member health plan, all of which leverage an estimated $6.1 billion positive impact on the Pennsylvania economy. The health system and the health plan have repeatedly garnered national accolades for integration, quality and service. In addition to fulfilling its patient care mission, Geisinger has a long-standing commitment to medical education, research and community service. For more information, visit www.geisinger.org, or follow the latest Geisinger news and more on Twitter and Facebook.
Harborview Medical Center (HMC), managed by the University of Washington in Seattle, began using electronic health records in 1995. Since 2010, HMC has allowed online access to electronic health records for select patients in its HIV clinic and an adult medicine clinic using a patient portal as part of the OpenNotes study. In addition to their primary care visit notes, these patients can view laboratory, cardiology, radiology and pathology results. Many of HMCs patients are without regular access to computers at home and use public spaces, such as libraries, to access the Internet.
The hospital’s mission is to serve a broad population, including medically underserved patients, uninsured and underinsured populations, and homeless and incarcerated patients. Many patients have complicated medical conditions that co-exist with substance abuse or psychiatric illness.
The Department of Veterans Affairs (VA) is home to the United States’ largest integrated health care system, with over 1,700 sites of care serving 8.3 million Veterans each year. The VA is committed to transparency and patient-centered care by enhancing information and services available to Veterans online. The prototype of VA’s personal health record, the My HealtheVet Pilot, provided over 7,000 VA patients in nine facilities full access to their health record information. In 2003, My HealtheVet was launched nationwide and has continuously enhanced its capabilities. Offering medication refill, secure messaging, tailored wellness reminders and other services and information, My HealtheVet now boasts more than 2.2 million registrants.
In 2010, VA introduced the Blue Button, allowing Veterans to view, print, or save their personal health information. Users can download a file to a location of their choosing. Since January 2013, Veterans with a Premium Account have access to clinical notes in their VA Electronic Health Record, including outpatient primary care and specialty visit notes, discharge summaries and emergency department visit notes. In addition to access to test and imaging results, users can also view and download the VA Continuity of Care Document (VA CCD), a summary of important health information from the Veterans VA Electronic Health Record. The VA CCD is a standard electronic exchange document used for sharing patient information.
On Nov. 1, Columbia St. Mary’s Health System in Milwaukee became the first hospital in Wisconsin to implement OpenNotes. Over 1,100 multi-specialty doctors, nurse practitioners, and others who write visit notes, will be sharing them with more than 300,000 patients via a secure online portal. Columbia St. Mary’s is part of Ascension Health, the largest nonprofit Catholic health system in the country. This month, it also becomes the first hospital system to share hospital discharge summaries with patients.
Columbia St. Mary’s comprises four hospitals, Columbia St. Mary’s Hospital Milwaukee (including the Women’s Hospital), Columbia St. Mary’s Hospital Ozaukee, Sacred Heart Rehabilitation Institute and a partnership with the Orthopaedic Hospital of Wisconsin. In addition, there are 62 primary care clinics, the Columbia College of Nursing, and an affiliation with Madison Medical Affiliates. The system serves Milwaukee, Ozaukee, Washington and Sheboygan counties, with more than 164 years of service.
Columbia St. Mary’s and its sponsor organizations, Ascension Health and Columbia Health System, share a mission to make a positive difference in the health status and lives of individuals in the community with a special concern for those who are vulnerable. For more information, visit www.columbia-stmarys.org.