Twenty years Sunday, President Bill Clinton signed a law that health care changed profoundly in United States: Accountability Act and Health Insurance Portability Act (HIPAA). Much of the law focused on the protection of insurance coverage for people who change jobs, simplification of rules for healthcare data, and establishing standards protecting the privacy of care information health of Americans. But HIPAA also paved the way for better communication, more open between doctors and their patients.
Before August 21, 1996, was a major annoyance for most people to see their medical records – if they could see at all. A box of surprises of state laws governing access to this information often useful. While some states, such as Massachusetts, have passed laws protecting the right of individuals to obtain copies of their medical records, that right was not consistent across the country. In some states, you need to file a lawsuit to see your medical records. Others require you to show “good cause”. HIPAA basically says that every resident in the United States, with very few exceptions, have the right to see your medical records.
The HIPAA not do was make them easier to see.
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For years, medical records were kept on index cards or paper. They include dates of visits, diagnoses, prescription drugs, and the like. physician notes of each visit are also included. These information-rich documents serve to remind doctors about their patients and what was discussed at each visit, outlined the next steps, and more. Ideally, they told the story of the patient during times of health and disease.
How to buy your records meant going to the doctor or hospital, pay a visit to the department records, and then humbly request your information and agree to pay the fee of the copy. It could take days or weeks.
The development of electronic medical records that are possible a simpler way to share information among doctors and patients. Beth Israel Hospital in Boston (as it was known then) was one of the first hospitals to build an electronic medical record. Doctors dictate their notes or written to the database, and these notes became part of the record. And from the beginning, one of us (T.D.) often copies would be printed and mailed to patients.
Creating portals password protected patients represents an important next step. This allowed a two-way electronic exchange of information between patients and providers. Portals allow patients initially look up lab results, refill medications, schedule appointments, or maybe even send secure emails to physicians. Many doctors initially resisted the change, warning that patients would not be able to understand the results of laboratory or were flooded with emails. Nor true.
However, an important part of the history, note, remained hidden from view of patients. Traditionally, doctors ‘ownership’ of such notes, using them as reminders, as vehicles for sharing information with colleagues and, increasingly, as ways to justify the bills paid. But we feel that doctors, nurses, physical therapists and other clinicians could use a great opportunity: Why not share these notes with your patients? After all, good grades can accurately pull together stories of patients , evaluation of their bodies, their minds, and intermingling a variety of needs. The Institute of Medicine agreed, urging the society to view the note as a living document, interactive shared between patients and providers.
hope that by sharing this information, patients could more actively participate in their care, better remember what was discussed during the visit, follow more closely the care plan, do a job more effective adhesion to your , take greater control of their attention, and potentially collect their medical errors may have done. Any or all of these would improve the quality and safety of care and, over time, help reduce costs.
In 2010, took a step toward making note clinical part of the conversation between doctor and patient by performing an experiment relatively large scale we call OpenNotes, in which doctors invited to his patients to see your notes electronically. We started with 105 physicians and more than 20,000 patients at Beth Israel Deaconess Medical Center, Geisinger Health System in Pennsylvania and Harborview Medical Center, the hospital safety net in Seattle. We do not send patients an educational email from multiple pages on how to read clinical note, nor we spent hours educate physicians about writing notes that patients can see. Instead, basically, he flipped the switch that kept patients see their notes, and then evaluate what happened.
What we have learned from this demonstration a year far exceeded our expectations. More than 80 percent of patients at least read a note, whether or not they chose to read his notes, 99 percent said the practice should continue. Among those notes reading, 70 percent of those who completed the survey said they felt more in control, they were better educated about their care, and were being more conscious about taking your medicines. The latter finding was remarkable. Adherence to treatment has been a major problem in medicine for years. Doctors almost invariably overestimate how often patients take their medications and underestimate how difficult it is to take them. Improving taking medication behaviors of patients with something as simple as inviting them to read their notes was an amazing find. Even if these reports were an exaggeration five times, and only 15 percent of those were in fact reported taking their medications more effectively, OpenNotes was already worth it.
Here is another illustration, characteristic of what excited us about the responses of many patients to read what their doctors wrote example. One user commented: “In his notes, the doctor called me ‘moderately obese.” This led to my immediate enrollment in Weight Watchers and daily exercise. I did not think I had gained so much weight. I am determined to reverse that comment for my next checkup. “
However, changing the practice of physicians manner was, and is, a challenge. Some feared that sharing notes may valuable decrease of face to face communication with patients, patients would not be able to understand the medical language used in the notes, and even share notes raise more questions for patients to give answers. However, as practice extended, these fears were rarely realized, and today the arguments on the content and other contentious issues pale in comparison to the benefits of open communication, trust and commitment of the patient increasingly characterize the experience of physicians and the patients. This comment from a doctor seems to capture their collective experience: “My fears:.. Longer notes, questions, and messages of patients was actually not a big problem”
After completing the project demonstration and realization of a lot of follow-up investigation, we are now working to bring the potentially transformative experience of reading medical notes as many people as possible. OpenNotes , financed exclusively by philanthropy, has already brought clinical notes to 10 million Americans. Our goal is to reach 50 million by the end of 2018. We really want this practice to become the standard of care.
HIPAA is landmark legislation that has benefited many Americans. But it was written before anyone had fully realized the potential of electronic medical records. Its principles now need to evolve to adapt to new and different demands. For example, now it is possible for patients to add information to their medical records and notes, which owns the medical history is becoming an open question. And as patients move towards generating records with suppliers, how issues should be resolved when a patient and physician do not agree on the contents of a note?
Creating a two-way conversation between patients and providers can be very important to improve the quality and cost of care, patient safety and patient satisfaction. We are increasingly convinced that the expansion of these conversations will help patients become more active partners in their own health care.
Jan Walker, RN, is co-founder of OpenNotes and assistant professor of medicine at Harvard Medical School and Beth Israel Deaconess Medical Center. Catherine L. Annas, JD, is a project manager of quality improvement at the Beth Israel Deaconess Medical Center. Tom Delbanco, MD, is co-founder of OpenNotes and professor of general medicine and primary care at Harvard Medical School and Beth Israel Deaconess Medical Center.Additional Tags for this post:
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