By Lisa Rapaport
(Reuters Health) - In theory, patients might be more engaged with their care and better able to inform doctors about any health issues if they could directly contribute to their own electronic medical records, a small U.S. study suggests.
For the study, researchers interviewed 29 physicians, nurses, patient advocates and computer experts about the potential benefits and pitfalls of letting patients directly contribute to doctors’ notes. The interviews focused on OurNotes, a platform that lets patients co-produce medical notes with clinicians.
Overall, people expressed mixed feelings. These contributions could improve care, make checkups more efficient and save physicians time, participants said. But it’s also possible that reviewing what patients add to the notes could encroach on doctors' already scarce time without making care any better.
“Broadly speaking, OurNotes is an open acknowledgement that healthcare (particularly chronic disease healthcare) is continuous, requiring full-time engagement and not completely determined by 15-minute visits 2 to 4 times per year,” said lead study author Dr. John Mafi, a primary care physician at the David Geffen School of Medicine at the University of California, Los Angeles.
“OurNotes has the potential to improve care directly by allowing patients and families to set their agenda ahead of time and update their past history, potentially saving time during the actual encounter and allowing for a more accurate medical history,” Mafi said by email.
“If not executed thoughtfully, it may unintentionally add workflow to busy clinicians who have to review lengthy non-relevant patient data, and adding to busy clinicians’ workflow is a nonstarter,” Mafi added.
Overall, participants were most supportive of the idea of asking patients to review records and contribute new information before upcoming appointments, researchers report online November 13 in Annals of Internal Medicine.
Keeping these contributions structured and limited in length would help empower patients to provide critical information without creating a huge burden on providers to sift through an overly detailed account of unessential information, the interviews found.
Many participants, however, thought it might not be realistic to get patients to do this work on their own time, outside the context of an office visit.
Some patients might be intimidated by the technology or the nature of the questions, or both. And some patients simply might not want to contribute to their records, preferring to discuss their health with clinicians in person.
Patient contributions would also only be helpful if reading and responding to this information didn’t interrupt clinicians' workflow or create extra work.
Beyond its small size, another limitation of the study is its non-random selection of participants and its lack of direct patient participation, the authors note.
Still, researchers are continuing to test OurNotes in several settings; for example, to get input from patients before primary care checkups.
“One upside could be making patients feel like doctors value their perspective, which isn’t always the case now,” said Dr. Monika Safford, author of an accompanying editorial and chief of general internal medicine at NewYork-Presbyterian/Weill Cornell Medical Center in New York City.
“A lot of patients don’t understand a word the doctor says and are too afraid to challenge them with questions,” Safford said by email. “This is especially true for the elderly and minorities.”
Currently, patients don’t always prepare questions or complete paperwork before appointments even when doctors ask for this, and physicians may also fail to read any information patients do provide, Safford added.
“So everyone is not on the same page, so to speak, at the current time,” Safford said. “Allowing patients to enter their (recent) history and concerns would standardize this process and could possibly increase the number of patients who feel truly engaged in their care.”
SOURCES: http://bit.ly/2AE5HKW and http://bit.ly/2zUuTjJ
Ann Intern Med 2017
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