The OpenNotes project, now with more than 5 million participants, has proven highly successful in engaging and satisfying patients. Based on early research presented Monday at the American Medical Informatics Association annual symposium in San Francisco, providing patients with full access to their medical records seems to work pretty well in inpatient environments, too.
And, as with OpenNotes, clinicians initially were apprehensive about opening up so much information to their patients, but most eventually came around to see the benefits of this kind of patient engagement.
That certainly was the case at the University of Colorado Hospital, at least in the context of a small study conducted there. “We should share knowledge and we should be completely transparent with our patients,” said Dr. Jonathan Pell, a hospitalist and informatics champion at the Denver facility.
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Nearly two-thirds of physicians, physician assistants and nurses said at the outset of the study that giving patients immediate access to inpatient test results would result in more questions from patients and greater workload for clinicians. The opposite actually happened, Pell said. “Consistent with outpatient studies, patients answered more positively to empowerment questions after being given EHR access,” read the abstract that accompanied Pell’s presentation.
However, more than 90 percent of participating healthcare professionals said that patients access to medication lists would help them find errors, compared to 44 percent of patients who expressed that sentiment. The results were closer to what patients expected.
A 67 percent supermajority of patients also thought at the outset of the study that immediate access to their records and test results would help them better understand when they would be discharged. It turned out, however, that just 42 percent had the same answer at the end of the study period, in March 2013. This, according to Pell, suggests that nurses have to do a better job educating patients about hospital discharge and in providing post-discharge instructions.
Another paper, presented by Brent Hill, a biomedical informatics researcher at the University of Utah Hospital, backed up the finding that patients struggle to recall discharge instructions. “We know that we’re not providing the best information,” Hill said.
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Patients are given a lot of information in a short period of time, but they might be heavily medicated, fatigued because it’s often difficult to sleep in hospitals and have low health literacy.
A study of 50 patients discharged from a cardiovascular unit at the Salt Lake City found that while 78 percent remembered their diagnosis, only 26 percent were able to recall instructions for wound care, 24 percent for dietary restrictions and 22 percent for recommended post-discharge activity levels.
