- Does patient access to clinician notes – a movement known as OpenNotes – help or hinder the patient provider relationship? That depends on what the notes say and the strength of provider communication, according to a research team from the Veterans Affairs Portland Health Care System.
The study was published in the journal Psychiatric Services and included qualitative interviews with 28 patients receiving mental healthcare through the VA. All patient participants had OpenNotes access, meaning they viewed their clinician notes that were a part of their individual health records.
"We found that reading mental health notes may strengthen as well as strain patient-clinician relationships by enhancing or undermining trust," wrote the report’s authors, who are a part of the VA’s Center to Improve Veteran Involvement in Care (CIVIC).
When patients did report positive perceptions of OpenNotes, it was because clinician notes were consistent with what patients and providers discussed during an appointment. This consistency indicated clinical transparency, which ultimately led to more trust between patient and physician, the researchers said.
Patients also reported feeling respected when clinician notes showed that the physician truly listened to patient issues during the clinical encounter. When clinician notes contained specific anecdotes, issues, or other information from the appointment, patients felt understood as individuals.
However, when clinician notes were not transparent, OpenNotes hindered the patient-provider relationship. Patients disliked when clinician notes and the clinical encounter were inconsistent and when there were errors, gaps in information, or outdated information within the clinician notes. Patients expressed concern that inaccurate information could impede future care encounters with other clinicians, the researchers said.
Additionally, patients reported dissatisfaction when they saw potential diagnoses within the clinician note that they hadn’t yet discussed with their doctors. This lack of transparency was a considerable barrier to a trusting patient-provider relationship.
Healthcare providers must address all aspects of patient care and practice health transparency when utilizing OpenNotes to mitigate these issues, said lead author Risa Cromer, PhD, and senior author Steven Dobscha, MD, Director of CIVIC.
OpenNotes is growing at a significant rate. With the VA being one of the pioneer organizations leveraging the strategy, it is unlikely VA providers will see it go away anytime soon. The VA must develop better methods for fostering strong patient-provider communication while also offering open access to clinician notes.
"Proactive clinician communication with patients about the content of notes and the note-writing process, as well as documenting strengths and highlighting the individuality of patients, may improve the likelihood of maintaining or developing stronger therapeutic alliances between patients and clinicians in the context of OpenNotes," Cromer and Dobscha wrote.
A deteriorating patient-provider relationship was one of the primary fears that many providers – including those outside the VA – had when adopting OpenNotes. UCHealth Chief Medical Information Officer CT Lin, MD, FACP stated that clinicians across the country had apprehensions about adopting OpenNotes specifically due to concerns about patient reactions.
“’Progress notes are for doctors,’ providers had said. ‘Terminology is hard to understand. Do you not think we’re working hard enough already? Do you want patients to call us with terminology questions? Will they be offended when we call them obese? Or if we say they’re smoking or they smelled like smoke? This is going to be terrible,’” Lin said, recalling the negative reactions he’d received after introducing UCHealth’s pilot version of OpenNotes, SPPARO (System Providing Patients Access to Records Online).
However, providers had a change of heart when they saw their clinical encounters and patient engagement improve as a result of OpenNotes, Lin stated. When patients reacted positively to open clinician note access, providers became more likely to get on board.
Ideally, positive examples such as that at UCHealth or some patients at the VA will motivate providers to conduct stronger, more transparent conversations with their patients. In doing so, providers can help patients better take advantage of OpenNotes and become truly engaged in their own healthcare.