Sometimes it's the simplest thing that makes the biggest difference.


Take patient engagement. Health care is complicated and, when in a vulnerable state, patients can feel overwhelmed. Still, an informed patient can serve as a tremendous partner to his or her clinicians. After all, health care is a team sport, right? And as care delivery moves toward greater accountability for providers and information becomes accessible, patients are well positioned to truly be at the center. The simple act of providing patients with a timely and accurate accounting of their condition and treatment will go a long way toward creating an informed and, hopefully, engaged patient.

The key word here, though, is "informed." Informed and shared decision-making are things that the field has been talking about for what seems like eons. I recall writing about the novel concept when I first started reporting on health care back in the mid-1990s.

"There are a couple of issues that have made progress slower than what we would like," George Bo-Linn, M.D., told me during a recent interview. "The first is that it is a bilateral process. Health care professionals need to want the participation of patients and families in decision-making, which begins with inviting that participation and includes providing information in a fashion that the patient and family understand enough to participate meaningfully. And the patient and family need to want to learn more and understand that decisions are not always clear in terms of black and white; that there are nuances."

Bo-Linn heads a new 10-year, $500 million initiative by the Gordon and Betty Moore Foundation aimed at improving patient engagement. A complete interview with Bo-Linn appears in the October issue of H&HN, which will be online next Tuesday; paper copies should hit your desks next week as well. One of the first steps is creating an environment where patients can access their complete record. To a degree, this was the focus of a study published earlier this week on the Annals of Internal Medicine website. The study took a look at what would happen if primary care physicians allowed patients to review online the notes that the doctors wrote following an office visit. More than 100 physicians and over 13,000 patients participated. The study included physicians from Beth Israel Deaconess Medical Center, Geisinger Health System and Harborview Medical Center and they used a system called OpenNotes, which aims to encourage better communication between physicians and patients.

What did they find?

  • 84 percent of patients at Beth Israel, 92 percent at Geisinger and 47 percent at Harborview opened at least one note.
  • Of 5,391 patients who opened at least one note and completed a survey, 77 to 87 percent across all three health systems said that the note made them feel more in control of their care; 60 to 78 percent reported increased medication adherence; 26 to 36 percent had privacy concerns.

"Patients were enthusiastic about open access to PCP visit notes; 99 percent of those who completed surveys recommended that this transparency continue," the authors noted. "Perhaps most important clinically, a remarkable number reported becoming more likely to take medications as prescribed."

With payment penalties for high readmission rates now in place, anything that can help achieve greater patient adherence to medication regimens warrants serious consideration, don't you think?

The authors noted that some physicians balked at participating, mainly fearing that it would increase their workload and that patients would get confused. The survey found that just 1 to 8 percent of patients said that the notes caused confusion, worry or were offensive.

As many of you know, federal criteria for meaningful use of health IT requires that hospitals be able to provide a patient with an electronic version of their record. It doesn't stipulate that notes be included, but if we are going to get to the point of a truly informed patient, and one that is engaged in his or her health care, well, this study would suggest that the simple act of providing that access is a good step.

Caroline Lubick Goldzweig, M.D., Veterans Affairs Greater Los Angeles Healthcare System and the University of California, Los Angeles, put it more eloquently in an editorial that accompanied the survey, saying that "a revolution is occurring in health care documentation with the widespread implementation of electronic medical records, particularly the development of patient portals. Patients, many of whom already have access to some electronic medical information, have become savvy consumers of online health information, and will demand more. The way that we as physicians view the medical record needs to change accordingly."