Harborview Medical Center

Using “OpenNotes” to Increase Transparency in Care

Advances in health information technology have helped make medical records and health information more accessible to patients, thus allowing them to have greater insight and input into their own healthcare. However, most patients do not read what’s at the core of health care records - the doctor’s note. Allowing patients to view the doctor’s note may improve their understanding of their health, increase patient-doctor communication, stimulate shared decision making, and lead to improved health outcomes. Yet, some patients and providers are concerned that offering patients access to the notes may also lead to negative consequences, including increasing a patient’s confusion or anxiety, disrupting patient-doctor communication, and increasing the time demands on physicians and staff.

To ascertain the feasibility, benefits and potentially negative consequences of allowing patients to access their physicians’ electronic doctors’ notes, a demonstration and evaluation project called “OpenNotes” was launched in the summer of 2010. The project involves more than 100 primary care physicians (PCPs) at three hospitals across the country, including those at Harborview Medical Center’s Adult Medicine and Madison Clinics in Seattle, Washington, who have volunteered to invite their patients to view their doctor’s notes, as well as radiology, pathology, and lab reports via secure electronic portals.

Harborview Medical Center serves a wide range of patients, but is renowned for its service to vulnerable and historically marginalized populations.

During the planning stage of the demonstration project, doctors and patients suggested several potential benefits to allowing patients to have increased access to their doctor’s notes, including: 

• Improved understanding of the patient’s medical condition; 
• Increased patient participation in care and adherence to treatment; 
• More eyes on documentation, which may lead to reduced medical errors; and, 
• Greater patient trust.

Several potential drawbacks were also noted in focus groups: 

• Patient misunderstanding of medical terminology; 
• Patients taking offense over descriptions of the patient, the encounter, or both; 
• Need for additional clinician time to address issues with the note.

Those leading the demonstration believe that as the project progresses and spreads, “OpenNotes” can, when drafted collaboratively by the physician and patient, become contracts of care.

For more information on the “OpenNotes” Demonstration and Evaluation Project at Harborview Medical Center, contact:
Natalia V. Oster, MPH
Research Consultant
General Internal Medicine, University of Washington
[email protected]  

Paula Minton-Foltz, RN
Assistant Administrator, Education, Quality, and Patient Safety
Harborview Medical Center
206-744-4075
[email protected]