How physicians feel about open notes access

A study on ophthalmologists’ opinions on open notes, published recently in Nature, found that many think their patients will have trouble understanding their medical records and may be unnecessarily distressed and/or offended by them. The survey of 29 clinicians at the University of Colorado’s ophthalmology department also found that some were worried that open notes requirements would increase their workload and force them to change the way they document.

The same clinicians also listed benefits to open notes, including improving patient understanding of their conditions, strengthening patient–physician trust, and enhancing patient care.

Due to a program rule for implementation of the 21st Century Cures Act, health care professionals have been required to give patients access to all health information in their medical records without delay since April 2021.

One caveat to the Nature study is that the survey was conducted before open notes were implemented at the University of Colorado, meaning it provides a snapshot of concerns and perceptions among physicians who were not yet working with open notes. Also, the study noted that ophthalmology notes are unique in that they heavily use drawings and non-standardized abbreviations; they are often incomprehensible to other clinicians, let alone patients.

“This study suggests that ophthalmology clinicians may have fears and concerns regarding the implementation of OpenNotes that differ significantly from those of other clinicians,” the study authors wrote. “As such, health systems implementing OpenNotes should recognize the unique challenges that note-sharing poses in ophthalmology, educate ophthalmology providers on the benefits of note-sharing, and collaborate with these providers to work toward the goal of making notes more comprehensible to patients.”

Physician attitudes before and after open notes implementation

Another recent study of physician attitudes about open notes provided survey data from 192 physicians across multiple specialties from before and after open notes were implemented at their institution. Published in the Journal of General Internal Medicine, the study revealed that prior to implementation, only 29% of the physicians thought open notes were a good idea. Roughly 44% of the physicians went from thinking open notes were a bad idea to believing they were ultimately beneficial.

The study suggests that physician concerns about the negative impacts of open notes on their day-to-day practice of medicine were significantly reduced after open notes were implemented. However, a number of physicians remained worried after implementation.

Interestingly, more physicians also reported being less candid in their notes following implementation, and they also were more likely to think patients with open notes access would worry more about their treatment or conditions.

“Compared to before implementation, substantially fewer clinicians thought open notes increased patient safety and satisfaction,” the study authors wrote. “Perception of improved satisfaction dropped over one-half, from 40% to 17%, and perception of safer care dropped from 33% to 11%. These changes further reflect the less-than-anticipated impact of open notes on practice. To realize its potential to improve safety, quality, and experience of care, open notes may need to be coupled with additional interventions.”

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