Access To Notes Empowers Patients In Pilot Study

By Christine Kern, contributing writer

Beth Israel Deaconess Medical Center sees promise in OpenNotes mental health pilot.

Psychiatry and social work clinicians report positive results from the mental health pilot at Beth Israel Deaconess Medical Center, an attempt to measure the use of OpenNotes to share mental health notations with patients.

Beth Israel Deaconess Medical Center (BIDMC) in Boston – an academic medical center affiliated with Harvard Medical School – employs approximately 2,400 clinical staff, including 800 physicians and 1,200 registered nurses. BIDMC has 649 inpatient beds, and offers both hospital- and community-based ambulatory care. BIDMC developed its EMR beginning in the 1980s and opened its patient portal, PatientSite, in 1999. Approximately 75,000 patients have PatientSite accounts.

BIDMC’s first initiation of OpenNotes came in 2010, when it opened notes to patients of 39 volunteering primary care physicians. On review of that study’s results, the hospital’s Clinical Operations Executive Committee voted to open all clinicians’ notes.

Since the trial began in March, approximately 1,000 patients have had electronic access to therapy notes written by their psychiatrists, psychologists, and social workers. Beth Israel is the first private hospital system to do so, and the practice has set off a spirited debate among mental-health professionals and patients.

“We can certainly say at this point, the angst which most clinicians feared by sharing their notes is not materializing,” Stephen O’Neill, social work manager for psychiatry and primary care said in the release. “It has been strikingly quiet in this regard, with scattered exceptions. The vast majority of our patients are reporting that the notes are helpful and often clarifying. OpenNotes is not an end, it is one more means in giving our patients tools to assist them. Most patients report that it helps them to feel more in charge of their life and in a better ‘partnership’ with their clinical team.”

At BIDMC, OpenNotes has become the norm for ambulatory care. In most services, after a note is signed, patients receive an automated email notifying them that a note is available to be read on patientsite.org.

Not all clinicians at Beth Israel have signed on to the program however, according to Delaware Online. Some have concerns about the process, and believe that therapists' notes about patients' behaviors and feelings are fundamentally different from medical assessments about diabetes and hypertension.

Revealing psychiatric notes to patients could, they believe, make some patients feel unfairly judged, and could potentially trigger destructive or unhealthy responses. The fear of patient response could also lead psychiatrists and therapists, worried about patients' reactions, to censor their own note-taking.

“Bringing transparency into mental health feels like entering a minefield, triggering clinicians' worst fears about sharing notes with patients,” said Michael Kahn, a psychiatrist at Beth Israel, according to Delaware Online. Kahn is taking part in the pilot program.