Would you help write your own medical records if you could?
A study published in the Annals of Internal Medicine found patients may benefit from co-producing medical notes with their physicians.
Called “Our Notes,” the program’s goal is to improve patient engagement and relieve some of the pressure on physicians with demanding schedules.
It follows the success of an international movement known as Open Notes, in which patients were invited to read their own medical records.
“The next logical step is moving beyond just passive reading of notes and inviting patients to co-write the note with the clinician and that’s the concept of Our Notes,” Dr. John Mafi, author of the study and an assistant professor of medicine at the University of California Los Angeles (UCLA), told Healthline.
He says that Our Notes, which is still in trial phases, has the opportunity to change how healthcare in the United States is delivered.
“There is potential to really improve efficiency and make sure the patient’s voice is heard and make sure that the patient’s values, preferences, and goals are being expressed because right now the EHR (electronic health records) don’t really explicitly invite patients to express their own voice, even though the record is about them,” Mafi said.
Helping patients and doctors
Our Notes proponents hope that improving patient engagement by inviting them to contribute to their notes will lead to better health, and address one of the long-held challenges of healthcare.
“The idea of getting patients engaged is really one of the million dollar questions in healthcare delivery: How do you get patients more engaged in their own care?” Mafi said. “We really haven’t seen in the literature any kind of magic bullet to suddenly get patients more engaged.”
“Observational studies have found when patients are more engaged in their healthcare they have better outcomes,” he added.
A 2016 study that examined how much time doctors spend making notes found that for every hour a physician spends face to face with a patient, they spend two hours contributing to the electronic health record, or other desk work.
The study also found that outside office hours, physicians spend one to two hours of their personal time doing additional computer or administration work.
It’s hoped that the Our Notes program will reduce the amount of time physicians spend on medical records.
“There’s a fair number of hours physicians are doing, after they get home and see their kids and put them to bed and open up the laptop and continue to do some documentation. Anything that could help reduce the volume of documentation the physicians do, I think is a good thing all round,” Dr. Steven Waldren, director of the American Academy of Family Physicians’ Alliance for eHealth Innovation, told Healthline.
A study supported by the American Medical Association (AMA) found that during working hours, doctors spend around 27 percent of their time on direct contact with patients and 49 percent of their time on electronic health records and desk work.
Electronic health records have been identified as a significant contributor to physician burnout, emotional fatigue, and job dissatisfaction.
Mafi said it’s hoped that Our Notes will be able to combat physician burnout.
“It’s a big concern because there’s a lot of physician burnout and distress, so one of the hopes of Our Notes… is that if you invite the patients to enter in their symptoms and update their past medical history before the visit and that gets automatically populated into the visit notes — that may actually reduce the amount of workload burden on clinicians and that may be a big benefit for clinicians,” he said.
Mafi said that patient-generated information is often more accurate than physician filtered notes, particularly for things of a sensitive nature like sexual history.
He said that people are more likely to be honest when entering details like this into a computer, rather than telling a physician in person.
Patients who participated in Open Notes, the precursor to Our Notes, reported feeling a sense of empowerment. It’s hoped that furthering patient interaction through Our Notes will produce similar results.
“The physician-patient relationship and that team-based approach, I think, is critical to delivering good quality care for patients to optimize their health,” Waldren said.
Trying the system out
Our Notes will now undertake a trial pilot program at four locations.
They are Beth Israel Deaconess Medical Center, Dartmouth Medical Center, University of Colorado, and the University of Washington.
Mafi is optimistic the program will be well-received.
“Our Notes really has the opportunity to make care more patient-centered, to really make sure the patient’s voice is heard, and if it can offload work off the clinician that would be incredible so that’s the hope for these pilot studies,” Mafi said.