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Summary
The OpenNotes Collaborative is an initiative that invites patients to review their visit notes written by their doctors, nurses, or other clinicians. This collaborative is part of a national effort to promote and examine the impact of increasing transparency in care by inviting patients to read and contribute to their medical records.

Shared Visit Notes
Visit notes summarize what is discussed between the clinician and patient and what the clinician found or measured during the appointment. Patients have the right to review their medical records, including the notes clinicians write. With the spread of Electronic Health Records, and the development of patient portals many patients securely view their appointments, prescriptions, test results, and other personal health information. However, Notes have been traditionally closed to patients. As early as the 1960s and 1970s, clinicians have advocated for patient access to records. Clinicians have suggested that medical records could serve as a valuable educational tool for patients, and patients would benefit from having copies of both inpatient and outpatient records. Sharing visit notes is not dependent on a computerized record system. One family physician in Kansas has been printing out his notes for patients since 1986.

The OpenNotes Study
The OpenNotes Collaborative began as a yearlong experiment to investigate patients and doctors’ attitudes about sharing a visit note. Jan Walker and Tom Delbanco of BIDMC are the two primary investigators of the OpenNotes study. Primary care doctors at three health centers (BIDMC, Geisinger Health System, and Harborview Medical Center) invited their patients to read their visit notes online via patient portals. After a 12 month trial, 105 doctors and over 19,000 patients reported on their experiences Doctors were cautious and held widely varying views including concerns about greater demands on their work lives, frightening  their patients, and compromising quality if they changed the way they wrote notes. After the study, 0-8% of doctors reported taking more time to address patients’ questions outside of visits. 0-21% of doctors reported taking more time writing notes.

Patients were enthusiastic about shared visit notes: 77-84% of patients reported better understanding of their health and medical conditions. 77-87% felt more in control of their care. 60-78% reported doing better with taking their medications. 99% of patients wanted open notes to continue and 85-89% of patients said availability of open notes would influence their future choices of doctors and health plans.

Criticism
Critics cite several challenges to implementing open notes in medical care practices. Concerns include how open notes may further complicate difficult cases where patients may be experiencing possible mistreatment, substance abuse, and dementia.

Growth
Additional early adopters to the practice of open notes include MD Anderson Cancer Center and the Mayo Clinic. MD Anderson has been giving patients and their referring physicians access to their electronic medical records, including visit notes, since May 2009. The VA announced in January 2013 that OpenNotes will be part of their BlueButton.

Recognition
The OpenNotes study was recognized as one of the Robert Wood Johnson Foundation’s Top 5 Most Influential Research papers in 2012. The practice of open notes was also featured in the Wall Street Journal as one of the 10 healthcare innovations that will change the care patients receive in 2013.

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