The Importance of Reviewing Doctor's Notes and E-mail Reminders

As millions of patients nationwide increasingly gain access to clinicians’ notes, explicit e-mail invitations to review notes may be an important link in fostering patient engagement and patient-doctor communication, according to a new study.

Research published in the Journal of the American Medical Informatics Association examined the frequency with which patients invited to review their clinicians’ notes continue to access them. The findings also assess the impact of reminders on patients to encourage them to continue viewing notes. John Mafi, MD, MPH, a professor at the David Geffen School of Medicine at the University of California Los Angeles, and colleagues found that a simple note from a primary care doctor can be critical in encouraging patients to get more involved in their own healthcare.

Study Process

Data from the OpenNotes trial participants at Beth Israel Deaconess Medical Center (BIDMC) and Geisinger Health System (GHS) was used for 2 years. For the purpose of experimentation, patients were sent reminders repeatedly to view their doctors’ notes for one year. However, these reminders were discontinued after the first year to assess the impact of reminders.

The study findings were as follows:

• From the 14,360 final participants, the mean age was 52.2 years, and 57.8% were female.
• In the first year, 53.7% of BIDMC patients and 60.9% of the GHS patients viewed their notes. Their interest continued for the year.
• However, in year 2, things changed between the 2 groups when the electronic reminders were discontinued. In the second year, BIDMC patients viewed notes with similar frequency (except for a miniscule drop in percentage). But GHS patients viewed notes far less frequently—only 13.2%.
• Compared to black patients, white patients were more likely to review their notes. While 55.1% of white patients viewed their notes, only 36.3% of black patients did so.

Reminders Encourage More Involvement

The research was intended to enhance patient-engagement in their own care and to improve communication between patients and their doctors. Through reminders and regular reviewing of doctors’ notes, patients demonstrated better recall of their medical plans and felt more in control of their care. At the same time, doctors also said sharing notes with patients an effective exercise, as it didn’t have any negative impact on the existing workflow anyway.

However, this isn’t enough. Over a period of time, patients lose enthusiasm to review the notes and forget to take active participation in their own health. Often, after some time has elapsed, patients tend to forget the doctors’ words/notes, and in fact remember it wrong. Hence, the importance of reminders to view notes.

“While we predicted that reminders would influence patients’ viewing their doctors’ notes, we did not anticipate the large role that reminders seem to play in patients continuing to access viewing their notes,” Dr Mafi said. “We encourage people to ask their doctors or other healthcare professionals about whether they have access to their notes, and to make it a habit to view them.”