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Opening Notes to Close a Communication Gap

Visit notes boosts patient engagement
August 11, 2015

Photo of hands typing on a laptop with a stethoscope in the foreground

Photo of hands typing on a laptop with a stethoscope in the foreground
Associate Professor Lee-Ann Breuch of the Department of Writing Studies and a team of students set out to learn whether communication between doctors and their hospitalized patients would improve if patients could read what their doctor had written about their care.

For many of us, hospitals evoke a persistent buzz of low-key anxiety. The long hallways often smell faintly of antiseptic and worry. Is there a role that doctors could play to help patients and their families better understand their care and perhaps alleviate some of that worry? An interdisciplinary study by the University of Minnesota Medical Center (UMMC) with faculty and students from the College of Liberal Arts’ Department of Writing Studies discovered that doctors sharing their progress notes with patients and families helps a lot.

How can I have access to OpenNotes?
Use of OpenNotes is still in development,
and currently no hospitals are using
OpenNotes beyond small studies. However,
patients or family members of patients with
legal access to their care still have a right
to have access to their doctors’ daily notes.
Just ask, but know that delivery of
those notes may vary from hospital to hospital.

Can I benefit from OpenNotes even if I'm
not critically ill?

Yes. The benefits to you are the same no
matter your condition. This is significant because
researchers since the 1990s have tried to improve
communication between physicians and families
of seriously ill patients.

What if I disagree with what my doctor wrote?
This study also showed that patients may push
back on how physicians characterize something
about their illness or treatment. Generally,
doctors appreciated and took notice of these
insights that highlighted that patients may see an
issue differently than a doctor. In those cases,
each learned something about the other’s
which actually improved the quality 
of doctor-patient 

How can I learn more about OpenNotes?
You can learn more through the OpenNotes website.

Doctors opening their clinical notes to their patients is not a brand-new idea. But, physicians sharing their daily notes with hospitalized patients and their families is a new idea pioneered at UMMC, according to Dr. Craig Weinert, UMMC executive medical director.

Could OpenNotes Help Improve a Hospital Stay?

OpenNotes is an initiative that encourages partnerships among everyone on a medical team—including the patient—by providing everyone access to the same information, the daily notes written by doctors, nurses, and clinicians. UMMC has long used patient surveys to glean feedback from patients on their experience. However Weinert, who ran across the OpenNotes project in medical journals in 2012, thought this initiative might be key to improving doctor-patient communications and, by extension, the patients’ entire experience.

“The patient experience—including their impressions on the quality of physician communication—is an important measure of overall hospital quality,” said Weinert, whose job includes the oversight of patient satisfaction.

What the Team Learned from Patients and Families

Using OpenNotes in a hospital setting would be an enormous leap forward. Would patients and families understand the notes? Would doctors be overwhelmed with questions and arduous note-taking commitments? Would patients be upset by what they read? The only way to find out was to ask.

Weinert joined Professor Lee-Ann Breuch and a team of her students to conduct patient interviews. The study took place in six inpatient medical or surgical units at UMMC, including the intensive care unit. Most patients or family members agreed that doctors’ notes improved understanding of their condition or increased their feelings of empowerment and engagement in their treatment.

According to the interviews, patients and their families understood the notes. They liked that the notes could be used as a reference and to document their care. And while they were sometimes frustrated by medical jargon, many found ways to get the explanations they wanted. 

Emotionally, participants said they felt “reassured,” “safer,” and “more satisfied” with their care. One family member even said the notes documented the “swan song” of a dying patient. While some were discouraged by the inclusion of negative health information, even these patients appreciated that the notes reflected doctors’ efforts: “I want them to know I’m sick and treat me.”

Study Helps Patients and Future Researchers

The significance of this study can’t be overstated. For Breuch and her team of undergraduate and graduate students, it was an opportunity to study technical communication—communication about specialized topics, including medical writing—in action.

The partnership also represented one of those “only at the University” opportunities, where the proximity of UMMC to the writing studies department allows for the fertile exchange of expertise and experiences across disciplines.

“This was technical communication in the real world. This is people understanding important information about themselves,” said Breuch.  

Jacqui LaLiberte, an undergraduate studying technical writing and communication, conducted qualitative data analysis on interviews. “I didn’t know what to expect from patients, especially in the ICU. They were really, really sick. I was surprised that they were willing to be part of this to help other people.” 

LaLiberte also loved the chance to use her technical communication skills even before graduating. “Research opportunities are a great way to see your work translated into real world applications.” 

Those real world applications are vitally important. Sharing clinical notes with outpatients who have a routine doctor’s appointment is drastically different than sharing notes with the 33 million adult patients admitted to US hospitals annually. These patients are often in pain, sleep deprived, or cognitively impaired by medications while undergoing daily tests. Moreover, there is usually a team of specialists caring for the patient, not a single doctor. Ultimately, note distribution had minimal effects on doctors, even though they had to physically print out notes. There is currently no way to distribute notes electronically, but the vision is that eventually patients will view their doctor notes by tablet or similar means.

Promising directions exist for implementing OpenNotes more broadly. For example, there may be ways to integrate OpenNotes with existing electronic medical record systems. Regardless of how hospitals may use OpenNotes in the future, the benefits are clear for patients and medical staff alike.