Here’s the reality. A man I know has an elderly father who is fighting stomach cancer. One daughter lives close by and goes to most of her father’s medical appointments with him. The rest of the care team, including distant family members, the nurse and the doctor at the assisted living facility, and the primary care doctor, would love to know what happened in the appointment: what care changes were discussed, and what orders were prescribed.
The other challenge is that the elderly father is beginning to forget things, and so a faithful account of what he heard at the doctor’s office is inaccurate every time. How can patients remember and refer back to what their doctor has told them? How can extended care teams assist with appropriate interventions when they don’t attend the appointments? How can patients be more in control of their own medical care when they never take notes during the examinations? How do patients choose between care options if they cannot remember the details of those options? There must be a way for technology to help answer these pressing questions.
Providing Patients Access to the Visit Notes
As patients are driven to conduct more control over their healthcare (don’t you love those copays and high deductibles?), they are demanding to have more information about their care available to them. Access to the visit notes created during an encounter is one information source that is starting to emerge as a priority in order to support a patient’s self-management of care, as well as allow families to assist with the care compliance of a loved one. Having access to the visit notes created by a provider helps drive patient compliance with treatment processes. It also helps to eliminate any confusion about the care directives to the patient, especially when families are involved in the care process.
Having access to their visit notes allows patients to:
- Advocate for high-quality care. Sharing visit note information between PCPs and specialists can ensure that everyone is on the same page for ongoing care, especially with the lack of EHR interoperability.
- Easily review their provider’s care instructions, especially when they don’t correspond to the education or procedure preparation instructions that were provided to the patient.
- Have a family member engaged to help them through more difficult diseases, such as cancer.
Who Do You Trust?
We are seeing two different solution approaches in the market for provider/patient care documentation during an encounter. The first is the OpenNotes movement, and the second involves emerging digital applications that allow patients to record their visits using mobile devices.
The OpenNotes approach is designed to make healthcare more transparent by providing patients with access to the visit notes created by providers during and after the encounter. With this method, providers must open up the EHR to allow visit note access via patient portals, which may require physicians to modify their note formats. There may also be a potential medical record policy challenge with annotating notes the patient disagrees with. A key requirement for portal solutions is the ability to push information to the patients; they should not make patients search for information. Once this information is available in a patient portal, the patient should be sent an email or text notification about it.
The second approach is using digital applications on mobile devices where the patients initiate the visit’s communication recordings from their devices. With this method, patients have full access to and control over the visit note recordings for sharing with other care providers. These solutions may also create highlights of the visit’s medical terms, such as medications, diagnoses, and treatments, to make the information more patient friendly. The challenge with this approach may be with getting the provider’s permission to record the visit due to potential litigation risks.
The Players: An Org Versus Apps
The two key solutions to provide patients with access to their visit notes are:
- OpenNotes, which requires the EHR vendors to make standard visit notes available via their patient portals and potentially allows for physicians to change how they format visit notes.
- Abridge and Medcorder, which are digital applications that allow patients to record visit conversations on mobile devices.
Transparency is the New Healthcare Currency
As the market drives consumers to have more responsibility in managing their healthcare, it is critical that the patients are provided with secure, timely, easily accessible, and accurate information related to their healthcare encounters. The baby boomer, Generation X, millennial, and Generation Z populations will expect healthcare providers to become more transparent with their care processes and documentation. Providers who are not able to deliver access to patient visit notes may find their patients migrating to competitors.
A key benefit for sharing visit notes with patients is the ability to improve care quality and treatment outcomes. Engaging patients to be more involved in their care will reduce healthcare costs, and that is crucial to survive in the emerging fee-for-value reimbursement models.
- Creating clear and consistent medical record policies for providing patients with access to their visit notes.
- Establishing legal risk guidelines and instructions for physicians to allow patients to record their visits.
- Establishing a supportable and patient-flexible strategy by releasing visit notes via patient portals, allowing patients to use apps to record visits, or both.
Providing patients the ability to access and share their visit notes is a key success factor for improved patient engagement, which can drive improved quality of care and higher care outcomes. Extending the EHRs to provide visit notes via the OpenNote approach will require organizations to evaluate their patient portal designs and capabilities for easy access and intuitive notes. Allowing patients to record patient visits with their mobile apps engenders an environment of transparency, but may cause risk challenges if the provider’s visit notes are inconsistent with the patient-recorded visit notes. Well thought-out policies for allowing patients’ visit note recording apps and procedures that let patients share these recordings with providers will help reduce potential litigation risks. Whichever approach is used, the ability to share visit notes with care providers and family care providers is a win-win.