An Open Book

Medical terminology can be overwhelming, and despite the best efforts of nurses and doctors, a lot can get lost in translation. Now, for the first time, patients will have access to the notes doctors have made in their medical records through OpenNotes. The initiative, designed to improve communications between medical professionals and patients, is currently being tested in Massachusetts, Pennsylvania, and Washington State. Over 100 doctors and 25,000 patients across the three states are currently testing the project.

“People remember precious little of what goes on in a doctor’s office,” Dr. Tom Delbanco, M.D., at the Beth Israel Deaconess Medical Center in Boston, Massachusetts, notes during a video tour on the project’s website ( “It’s a high-stress situation for everyone, whether healthy or whether sick, and there’s lots of data that shows the memory for what happens in the doctor’s office or in the nurse clinician’s office is not very good.” Delbanco stresses the relaxed approach that home access brings. Via a secure website, patients can browse doctors’ notes at their own leisure.

But what does this newfound access to information mean? OpenNotes is more than just a digital record of physicians’ notes; it provides a streamlined way for patients to interact with their prescribing doctor. Doctors can update their notes after follow-up visits, phone calls, and e-mail correspondence and keep a cohesive record of everything the patient is experiencing. Notes can be presented in a variety of forms, including recorded sound bytes created by the doctor after the visit. It also gives patients the chance to double-check accuracy of notes in their file and correct errors more quickly.

However, many patients don’t even know that they have the legal right to view their doctor’s notes, the result of 1996 legislation under the federal Health Insurance Portability and Accountability Act (HIPAA). As the project continues its test run, there is a clear goal in mind: “The bottom-line evaluation of OpenNotes, to be assessed primarily through Web-based surveys, is straightforward: will patients and providers want to continue online access to notes when the year-long study ends?” says a perspective compiled by all participating doctors published in Annals of Internal Medicine.

“I think this may be a real step in transforming the patient and provider relation,” Delbianco says. “There’s lots of talk about shared decision making, there’s lots of talk about leveling the playing field, there’s lots of talk about not talking down to those whom we serve…My own hypothesis is that we’ll make for better health care and for healthier patients and a healthier citizenry.” Hypothesis, noted.