Massachusetts Health Data Consortium NewsA lot of doctors told us to go to hellRetrieved from Healthcare. ITNews. com   Boston Jan 9, 2. Tom Delbanco, MD, professor of general medicine and primary care at Harvard Medical School and former chief of general medicine at Beth Israel Deaconess Medical Center, is also co director of the Open. Notes project, which gives patients access to the clinical notes written by their doctors and nurses. Open. Notes initially launched in 2. BIDMC, Geisinger Health System and Harborview Medical Center in Seattle. It soon became apparent that what may have seemed, at first, to be a revolutionary concept had struck a nerve. This final rule finalizes a new edition of certification criteria the 2015 Edition health IT certification criteria or 2015 Edition and a new 2015 Edition Base. VMware, a global leader in cloud infrastructure digital workspace technology, accelerates digital transformation for evolving IT environments. Learn More Now. 9. Boundaries and Relationships. This resource is used to provide a single place within the health record to document a range of clinical statements about adverse. ValidationMessages.gif?version=1&modificationDate=1326317319000&api=v2' alt='Hl7 Messaging Second Edition Pdf' title='Hl7 Messaging Second Edition Pdf' />Over the past five years, the initiative which Delbanco first developed alongside BIDMC researcher Jan Walker, RN has grown almost exponentially, finding footholds at some of the largest and most prestigious providers in the country, including the VA, Kaiser Permanente Northwest, Oregon Health Science University and University of Colorado Health. On Feb. 1. 0, at the Healthcare IT NewsHIMSS Media Patient Engagement Summit, at the Hyatt Regency in Orlando, Delbancos BIDMC colleague, National Open. Notes Program Director Melissa Anselmo, will talk about why Open. Notes is such a hit with patients and, despite some initial resistance, most of the physicians who take part in it as well. In the meantime. Delbanco describes how the project has evolved thus far, and how it plans to expand to a truly nationwide movement. Q Open. Notes has experienced some pretty impressive growth since that first pilot in 2. A Weve gone from 2. Q Clearly this is an idea that had legs. So how did it all get started A Ive always thought the medical record is the hub of the wheel, the way to bring patients much closer to those who care for them. I did an experiment 3. I actually had patients walking around this hospital with records they kept and writing their own records along with the doctors writing theirs and saying, Lets compare notes. We published a paper about that, the doctors thought the patients were crazy. It was a little early. Then we got a grant in 2. Robert Wood Johnson Foundation to try this out in a big way using electronic portals. We asked doctors to volunteer in three settings. One is Beth Israel Deaconess, one of the big Harvard teaching hospitals. Another is the Geisinger Health System, which is this enormous integrated health system, serving rural Pennsylvania. And the third is Harborview, a safety net hospital in Seattle. We wanted three very different sites. A lot of doctors told us to go to hell. But we got more than 1. There were about 2. Q Did you notice any differences between those three very different localesA We found extraordinarily few differences, which was very interesting. Much fewer than we expected. Part of what helped our study was that we didnt just do it in one place, and that the findings, from both doctors and patients, were so similar. People felt it really had some generalizability to it. The intervention was very simple After the doctor signed his or her note, the patient automatically got an email saying, Tom just signed his note Mike, youre welcome to read, it. And then, two weeks before your appointment with your primary care doctor, you got a reminder email saying, You might want to review your notes. Thats all there was to it. A very simple intervention. All the vendors have them. But whats been hidden, up to now, is what the doctor writes, and what he or she thinks about you. You can look up your lab work, you can look up your X ray results, you can send secure emails, you can ask for appointments and refills. But you have not, in the past, been able to look up what the doctor wrote about you. Thats what the disruptive innovation is. Q You can understand why many doctors would be resistant to this. A Oh yeah. They had many fears that they said out loud. The biggest was that it would disrupt their workflow and primary care doctors feel overwhelmed already. The second was that it would scare the hell out of their patients. Those were the two biggest fears. And I think there were other fears I guess we can get into it, because weve been writing about it. Pauses. I think that notes are not always truthful. I asked an internist recently at a New England Journal of Medicine meeting, How many 4. Because of reimbursement in a fee for service world, doctors are really paid for their time and what they do. Weve had quite a few anecdotes now of a note that says, I spent 4. And the patient reads it and says, Wait a minute, you never touched me. And I think although the doctors wont say it out loud, thats one of the reasons theyre hesitant to do it. Now, when you go to population based care, when you go to ACOs, when you go to systems that reward quality rather than quantity, that doesnt become an issue anymore. You dont have to write that kind of note. Q The doctors who did sign on did they do so grudgingly, or enthusiastically A There was a broad range. Some were enthusiastic. Some kind of said, Well, its going to come anyway, I might as well try it. And some were, frankly, almost conscripted. So there was a range of expectations. About 8. 0 percent of the doctors who told us to go to hell felt it would mean more work for them. About 5. 0 percent of the doctors who volunteered also felt it would mean more work. We did a study before we started we studied the expectations of doctors and patients and then the study that got us all the attention was, after we had done it for a year what happened. We asked three basic questions First, will patients read their notes, and will they report benefits from them Number two, will it overburden the doctor And number three, after a year, will the patient and doctor want to continue They were very simple research questions. The results were that the patients were extraordinarily enthusiastic 8. That said, one out of five chose not to read their notes. I always make that point Freedom of choice. We had a wonderful quote from a woman in Maine who said, I want to have it, its all mine, its my business. But I may not read it. So, 8. The patients loved it. And more importantly they reported really important clinical benefits 7. They felt better prepared for visits. They remembered their visits better, which is a big issue you go to your doctor and you remember about 4. Plan Write Expert Edition. Its a high stress situation, even if youre well. Its a big deal. And the biggest deal of all is that about 7. Which, even if its a five fold exaggeration would be mind blowing. They also shared them with other people 3. Thats important. You share them with your aunt the doctor, or your cousin the lawyer. You can put them on Facebook if you want. The doctor patient relationship is confidential. But whether its private now is up to you. Serial Rapidweaver 5'>Serial Rapidweaver 5. You can download now and share with whomever you want and say, What do you think Youre in control. Its much more your record than it ever was. Q And the doctors What were their early thoughts A Not one doctor quit. They didnt all love it. They wrote their notes somewhat differently about a quarter of them did but not one quit after a year. And we now have thousands and thousands of doctors doing it and weve not heard yet about one whos started, then stopped. Partly, because I think patients just expect and want it. Eighty five percent of patients said it would help determine their future choice of provider whether or not Open.