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Empowering patients and reducing inequities: is there potential in sharing clinical notes?
  1. Charlotte Blease1,
  2. Leonor Fernandez1,2,
  3. Sigall K Bell1,2,
  4. Tom Delbanco1,2,
  5. Catherine DesRoches1,2
  1. 1 Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
  2. 2 Harvard Medical School, Boston, Massachusetts, USA
  1. Correspondence to Dr Charlotte Blease, Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02115, USA; cblease{at}bidmc.harvard.edu

https://doi.org/10.1136/bmjqs-2019-010490

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    Patients who read their clinical notes via online patient portals (‘open notes’) report that doing so engages them actively in their care, improves their sense of control over their health and enhances safety.1–3 In several surveys, patients who are older, less educated, non-white or whose first language is not English report even greater benefits than do their counterparts.2–4 However, for many reasons, persons from these demographic groups are less likely to use health portals than other patient populations.5 Drawing on promising preliminary evidence,2–4 6 we suggest that open notes may, over time, prove important in the care of patients who are at risk of experiencing healthcare disparities.

    Opening notes via electronic patient portals

    Consumers seek convenience, speed and security for their online data. In more than 10 countries worldwide—including Denmark, France, USA and Sweden—growing numbers of patients can now readily retrieve their clinical notes via portals.7 Studies suggest that the practice of sharing notes does not produce major disruptions to clinical workflow,1 and that clinicians with longer-term experience with the practice are more positive about it.8 For patients, evidence suggests strongly that the benefits of open notes outweigh the risks. In a recent large US survey conducted across three health systems with over 22 000 respondents, most reported that reading their notes was very important for taking care of their health (73%, 16 354/22 520), feeling more in control of their healthcare (70%, 15 726/22 515) and remembering their treatment plan (66%, 14 821/22 516).2 Surveys in Sweden indicate similarly that many patients feel more empowered and involved in their care as a result of reading their clinical notes.9

    Opportunity to improve health equity

    Disparities in health outcomes reflect multiple, often interrelated factors. They include environmental, economic, and social determinants, along with issues relating to accessibility and variable quality of the healthcare delivered. …

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    Footnotes

    • Contributors Conceived manuscript: CB. Wrote first draft: CB. Edited and revised: CB, LF, SKB, TD, CD.

    • Funding CB was funded by a Keane Fellowship.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement There are no data in this work.