Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

5 clinician concerns about OpenNotes

John Santa, MD, MPH
Tech
September 12, 2019
Share
Tweet
Share

More than 200 health organizations have now implemented OpenNotes. Many more are piloting, are soon to implement — or have implemented, and we don’t know it! For more than three years I’ve been fortunate to represent OpenNotes to potential implementers, and I’m confident I’ve heard almost every clinician concern or anxiety regarding what might happen when patients read their own notes.

Here are the five most common concerns I’ve heard — accompanied by why I think you can take a deep breath and direct many of your anxieties elsewhere.

1. “OpenNotes are going to cost too much money because of the EMR …”

While electronic medical record (EMR) vendors don’t support OpenNotes very effectively (for both patients and clinicians), at least they (e.g., Epic, Cerner, Allscripts, Meditech) make them available with no additional costs.

To implement OpenNotes, resources needed from a health system’s internal IT group are modest, and technology and/or direct tech expenses are rarely an issue. To be sure, above and beyond what clinicians think of them these days, many EMRs are also not very patient-friendly. But they will get there, particularly when they become more accountable to patients. Bottom line: EMRs are expensive, but those expenses are not a result of the patient-facing features.

2. “Our (fill in the specialty) is going to hate this …”

OpenNotes represents a real change for patients, and even more so for the culture of clinical practice. That’s the biggest obstacle. Patients applaud OpenNotes. Administrators rarely oppose OpenNotes. But some clinicians do, especially physicians.

Our research shows that many physicians are initially anxious, even those who support the general concept. But patients do not share that anxiety. Similarly, behavioral health clinicians worry, but their patients also see transparency as a huge positive. Moreover, creating barriers to transparency in a “behavioral health carveout” is a sign of persistent stigma assigned to mental illness. When it comes to OpenNotes, clinicians caring for adolescents may face the biggest challenge. They need to coordinate the needs of both adolescents and their parents while addressing state privacy regulations.

In summary, for many physicians, we find that OpenNotes is an acquired taste. But overall, large numbers of clinicians in every specialty have come to feel that transparent medical records offer significant benefits to their patients.

3. “Some of our physicians are poor documenters, and it would be embarrassing for a patient to read these notes …”

Such concerns are pragmatic. Some clinicians are indeed less than stellar documenters, have English as a poorly-mastered second language, are afraid of EMRs and associated technology, find themselves suffering from EMR burnout — or all four. Every organization struggles to respond to such challenges, and some are doing so more successfully than others.

I’ve seen lots of anxiety about these issues. But anxiety, when managed constructively, can be productive. For example, some organizations are reluctant to confront poor documenters. I don’t understand this. It’s bad medicine, bad business, inconsistent with the team concept and exposes everyone to risks — especially patients. On the other hand, some organizations have used OpenNotes as an opportunity to raise documentation standards, using it as a potent stimulus for making improvements.

4. “Patients will see we are up-coding!”

ADVERTISEMENT

Financially troubled organizations see the latest billing software as a way to solve their financial troubles and view that as a priority for all (although they won’t say that publicly). Did the doctor really see the patient for 40 minutes? Was there really a complete physical exam? When patients can see notes, they often recognize up-coding, and some will report it.

It bothers me when part of a business model involves making access to information difficult in order both to generate additional revenues in various ways and to avoid endangering patient loyalty. Our research justifies an opposite approach to helping the bottom line: Champion transparency as a strategy both to build loyalty and attract patients.

5. “My patients can’t possibly understand the notes …”

What saddens me most is clinicians opposing OpenNotes because they believe, or claim to believe that patients aren’t smart enough to understand notes, will be frightened, or will feel unleashed to call, email, or overcome any obstacle that protects the clinician’s private life. We have found just the opposite. We almost invariably underestimate how collectively resourceful patients and families can be, and how careful our patients are to respect their clinician’s time.

It especially disappoints me how often I see this caution articulated by clinicians who serve vulnerable patients and use the “can’t possibly understand” argument to avoid transparent communication. Our vulnerable populations are exactly those for whom we should be doing everything possible, in every way, to convey all the information we have, and help the patients understand it. And our research shows that, once introduced to OpenNotes, it is exactly these patients who report the greatest benefit from this new practice.

Bottom line: In our research, patients rarely report being confused by reading their notes. And those who are economically and socially disadvantaged especially value this transparency.

Finally, my best days come when I find clinicians who realize their impact will be maximized when the focus moves beyond face-to-face care. Need and demand for information exceeds any possible face-to-face strategy, and that means we have to become open to more creative information strategies that entail less clinician control and more patient autonomy and engagement.

Some clinicians assume such loss of control means more work and risk. It shouldn’t. All the good social science I see suggests that patients trust clinicians more than anyone else (all clinicians, not just doctors). And our research at OpenNotes suggests the same is true for the information offered by clinicians through their notes.

Patients are savvy. They trust, but want to verify…and when they do, trust increases even more. And that’s a wonderful experience. Try it.

John Santa is director of dissemination for OpenNotes, Beth Israel Deaconess Medical Center, Boston, MA.

Image credit: Shutterstock.com

Prev

Should doctors take more responsibility for quality metrics?

September 12, 2019 Kevin 7
…
Next

Scent of a hospital: a medical student's perspective in a developing country

September 12, 2019 Kevin 1
…

Tagged as: Health IT, Primary Care

Post navigation

< Previous Post
Should doctors take more responsibility for quality metrics?
Next Post >
Scent of a hospital: a medical student's perspective in a developing country

ADVERTISEMENT

Related Posts

  • An ode to great clinician-educators

    Robert Centor, MD
  • How to start reversing the clinician shortage today

    Timothy Lee, MPH
  • Are patients using social media to attack physicians?

    David R. Stukus, MD
  • How do we best handle the health concerns of our residents?

    Katie Fortenberry, PhD
  • We need a clinician review system with a personal touch

    Brittany Ganguly
  • Responding to medical students’ concerns and anxieties during these unprecedented times

    Kali Chiriboga

More in Tech

  • The promise and perils of AI in health care: Why we need better testing standards

    Max Rollwage, PhD
  • 3 tips for using AI medical scribes to save time charting

    Erica Dorn, FNP
  • Would The Pitts’ Dr. Robby Robinavitch welcome a new colleague? Yes. Especially if their initials were AI.

    Gabe Jones, MBA
  • Generative AI 2025: a 20-minute cheat sheet for busy clinicians

    Harvey Castro, MD, MBA
  • Why public health must be included in AI development

    Laura E. Scudiere, RN, MPH
  • Here’s what providers really need in a modern EHR

    Laura Kohlhagen, MD, MBA
  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • From Founding Fathers to modern battles: physician activism in a politicized era [PODCAST]

      The Podcast by KevinMD | Podcast
    • From stigma to science: Rethinking the U.S. drug scheduling system

      Artin Asadipooya | Meds
    • The gift we keep giving: How medicine demands everything—even our holidays

      Tomi Mitchell, MD | Physician
    • The promise and perils of AI in health care: Why we need better testing standards

      Max Rollwage, PhD | Tech
    • From burnout to balance: a neurosurgeon’s bold career redesign

      Jessie Mahoney, MD | Physician
    • Healing the doctor-patient relationship by attacking administrative inefficiencies

      Allen Fredrickson | Policy

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 4 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

  • Most Popular

  • Past Week

    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • How New Mexico became a malpractice lawsuit hotspot

      Patrick Hudson, MD | Physician
    • How community paramedicine impacts Indigenous elders

      Noah Weinberg | Conditions
    • Why doctors are reclaiming control from burnout culture

      Maureen Gibbons, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • Why are medical students turning away from primary care? [PODCAST]

      The Podcast by KevinMD | Podcast
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why “do no harm” might be harming modern medicine

      Sabooh S. Mubbashar, MD | Physician
    • Here’s what providers really need in a modern EHR

      Laura Kohlhagen, MD, MBA | Tech
    • How medical culture hides burnout in plain sight

      Marco Benítez | Conditions
  • Recent Posts

    • From Founding Fathers to modern battles: physician activism in a politicized era [PODCAST]

      The Podcast by KevinMD | Podcast
    • From stigma to science: Rethinking the U.S. drug scheduling system

      Artin Asadipooya | Meds
    • The gift we keep giving: How medicine demands everything—even our holidays

      Tomi Mitchell, MD | Physician
    • The promise and perils of AI in health care: Why we need better testing standards

      Max Rollwage, PhD | Tech
    • From burnout to balance: a neurosurgeon’s bold career redesign

      Jessie Mahoney, MD | Physician
    • Healing the doctor-patient relationship by attacking administrative inefficiencies

      Allen Fredrickson | Policy

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

5 clinician concerns about OpenNotes
4 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...