I’d like to look at a new practice that some clinics and hospitals are just now putting in place: making physician’s clinic notes accessible to their patients. As with any change, there are some facilities that are embracing the change…while others are running screaming in the other direction. It’s all part of the shift in focus in healthcare.
As most people and businesses will readily admit, the United States spends far too much on its healthcare. The chart on the left was prepared with 2011 healthcare spending data from the OECD (Organization for Economic Cooperation and Development), and points out that compared to many modern industrialized nations, we are spending nearly twice the adjusted percentage of GDP on healthcare as they are. Canada, France, Switzerland and Germany all hover around the 11% mark, meaning that they are spending approximately 11% of their GDP on healthcare. The US, by contrast, was spending 17.7% of GDP. You can read more about the information in this chart here.
Part of the idea behind bringing more technology into healthcare was to slow the explosive growth rate in our spending on healthcare, and hopefully to make it cheaper for everyone to access. Of course there are varying arguments about whether recent healthcare reforms have accomplished that goal. But one of the ideas behind adding new technology was to give patients greater access to their data, which in turn was supposed to support a transition in healthcare from a fee-for-service model to a model in which better patient care would be rewarded. To that end, prevention of complicated and chronic health conditions became a focus point because it allows you to kill two birds with one stone. If you give someone the tools to prevent a diagnosis of diabetes for example, you will save money on their care because diabetes and its complications can be costly to treat. Combine this with a shift in compensation to favor physicians who do a better job at preventing diabetes in their patients, and you have the framework to hopefully not only reduce the number of people who suffer from this debilitating condition, but also to slow the rise in healthcare costs over time.
To that end, many clinics and facilities have begun to add Patient Portals to their technology offerings. These web-based portals allow users to see their upcoming and recent doctor’s visits, view and maintain lists of medications/allergies and view lab results. Some of the more robust offerings also allow patients to contact their clinicians via e-mail or Instant Message, schedule visits using an online scheduler, update their family and medical history and request prescription refills.
Shefali Luthra at Kaiser Health News recently wrote a feature on a new technology that is opening up patients access to a previously unattainable set of data: Physician’s Notes. All of those writings and check boxes that doctors are adding to your record during your visit are compiled as a part of your medical chart, but they were never before accessible to the patients unless there was a lawsuit or other judicial order involved. Shefali Luthra profiled the benefits of giving patients access to these notes in her June 1st article What Patients Gain By Reading Their Doctor’s Notes on the KHN blog. She includes the story of a 70-year-old food broker who started making changes in his diet and exercise patterns after viewing physician’s notes of a recent visit that noted that he was pre-diabetic.
The article notes that advocates of these practices point out that it can help patients be more involved with their care, and can also help them catch mistakes or errors in their healthcare which may affect them down the road. They say it makes the doctor-patient relationship more of a team effort, which can have positive effects on the health of the patient, since patients can see information or observations that may have been glossed-over or ill-explained during the visit.
However, this practice also has its critics, and they do raise some legitimate concerns. First among them is that if physicians know that everything they write down can be accessed by the patient, they may begin selectively editing their notes. If they feel that a patient would be upset over a prognosis, for example, they may not be honest in the notes to avoid upsetting them; this in turn may lead to inadequate care later on. They also worry that some diagnoses are complex, and that a patient armed with their physician’s notes and Google or WebMD may dive into research only to become overwhelmed and confused by all of the information out there. Or worse, they may decide to try to treat the condition themselves, using home remedies or other advice found in some random corner of the internet.
I personally would appreciate having access to my physician’s notes after a visit. It is nearly impossible to remember everything that they ask you about (or ask you to fill in on those forms) during the typical office visit. Even during a yearly physical visit when you are feeling fine, remembering it all presents a challenge. But when you are acutely ill, it is even harder. I would also enjoy having access to the notes to see things that my physician may notice but may not tell me…for example if my blood pressure was creeping up over the years, I’d rather know about it as it’s happening than wait until a formal diagnosis of hypertension.
Are there dangers to putting this information out there? Absolutely, and not just from the data security standpoint (which would have to be discussed in a post of its own). You will always run the risk of someone trying to treat their condition with stuff that “some doctor” posted on some dark corner of the internet. Part of this could be improved with basic Medical Literacy which I spoke about in a previous blog post. But I do think that the benefits outweigh the risks. If you are trying to help the public make better decisions about their health, giving them more information about it is a key piece of the puzzle.