WIHI: OpenNotes: Doctors and Patients Are on the Same Page

Date: November 1, 2012


  • Tom Delbanco, MD, Richard and Florence Koplow–James Tullis Professor of General Medicine and Primary Care, Harvard Medical School
  • Robert D. Harrington, MD, Professor of Medicine, University of Washington; Medical Director, Harborview Medical Center HIV clinic; Associate Section Chief of Infectious Diseases, Harborview Medical Center
  • Richard Martin, MD, FAAFP, Department Director of Community Practice Service Lines (CPSL), Scranton and Monroe Counties; Director of Care Continuum, Geisinger Health System
  • Michael Meltsner, AB, JD, Matthews Distinguished University Professor of Law, Northeastern University School of Law, Boston, MA

Some changes in medicine are easier to contemplate than others. For a long time the notion that patients should be able to view what doctors write about them, following a visit, was unthinkable. It was a kind of “patient don’t ask, doctor don’t tell” policy. However, the growth of electronic health records, increased pressure for transparency, and the need to improve communication and understanding between patients and providers in every way possible are all tugging at information once considered off limits.

Despite the fear that “physician notes” have a tendency to be brief, even glib, and might unintentionally insult or alarm the reader, some health systems, like Dartmouth Hitchcock, have been successfully offering patients easier access to these notes, along with the entire electronic health record, for several years. [See the December 2009 WIHI: OpenNotes and the Electronic Medical Record.]

Still many more health systems have been on the fence, waiting for evidence that there’s value in doing so  and that the benefits outweigh the risks. Now that evidence seems to have arrived, and this WIHI digs into the experience of more than 13,000 patients and 100 primary care doctors who were part of a pilot study.

The findings appear in the October 2, 2012, issue of the Annals of Internal Medicine, reporting on a one-year experiment with what have come to be called “open notes” at three major health care organizations: Beth Israel Deaconess Medical Center (BIDMC) in Massachusetts, Geisinger Health System in Pennsylvania, and Harborview Medical Center in the state of Washington.

WIHI host Madge Kaplan welcomes lead author of the study, Dr. Tom Delbanco, one of the key innovators behind OpenNotes and their trial use at BIDMC, and two clinicians who helped lead the pilots at Geisinger and Harborview. By making notes accessible to patients in their own practices, both these clinicians came to better understand shared decision making and the ways in which transparency, rather than offend, increases trust. Michael Meltsner shares what mattered to him when he faced serious illness. A distinguished law professor, Meltsner’s “A Patient’s View of OpenNotes” also appears in Annals, and captures the brave new world of patient expectations and the need to level the playing field.



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