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OPEN NOTES: Are They For You? New Jersey Academy of Family Physicians Atlantic City, NJ June 22, 2013 Susan B. Orr, Esquire Tsoules, Sweeney, Martin &

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Presentation on theme: "OPEN NOTES: Are They For You? New Jersey Academy of Family Physicians Atlantic City, NJ June 22, 2013 Susan B. Orr, Esquire Tsoules, Sweeney, Martin &"— Presentation transcript:

1 OPEN NOTES: Are They For You? New Jersey Academy of Family Physicians Atlantic City, NJ June 22, 2013 Susan B. Orr, Esquire Tsoules, Sweeney, Martin & Orr, LLC 29 Dowlin Forge Road Exton, PA Tel.: (610) Fax: (610) Copyright© 2013 Tsoules, Sweeney, Martin & Orr, LLC

2 WHAT ARE OPEN NOTES? PCP’s inviting patients to read their office notes Patients engage with their PCP via web portals to access their health records (Meaningful Use Stage 2 Criteria) 2Copyright© 2013 Tsoules, Sweeney, Martin & Orr, LLC

3 OPENNOTES PROJECT Year-long study funded by $1.5 million grant from Robert Wood Johnson Foundation Purpose: demonstrate and evaluate the impact on both patients and clinicians of granting patients full access (via an electronic portal) to patient “medical records”, including all notes 3Copyright© 2013 Tsoules, Sweeney, Martin & Orr, LLC

4 OPENNOTES PROJECT 3 hospital participants: Beth Israel Deaconess Medical Center (Boston), Geisinger Health System (Danville, PA), & Harborview Medical Center* (Seattle) 105 Primary Care Practices at the Hospitals and 13,564 patients participated After an office visit, patients sent a secure stating when notes were available for viewing & told to review the notes prior to the next visit Study results were published 10/12/12 in the Annals of Internal Medicine * Had few participating patients 4Copyright© 2013 Tsoules, Sweeney, Martin & Orr, LLC

5 WHAT WAS AVAILABLE TO PATIENTS? Medical History Symptoms, Vital Signs Immunizations, Allergies Diagnoses Prescription History Lab & diagnostic test results NOTES 5Copyright© 2013 Tsoules, Sweeney, Martin & Orr, LLC

6 WHAT ARE PHYSICIAN “NOTES”? Document care and insights into a patient’s health and life for Dr.’s future reference Recorded during and after patient visits Includes both objective clinical data + subjective impressions of patient Subjective impressions include speculation about diagnoses or comments about patient (seems down, nervous; not getting along with spouse; possible drinking or memory issues) Recorded in free form text Historically not made available to patients Used to support insurance billing 6Copyright© 2013 Tsoules, Sweeney, Martin & Orr, LLC

7 PHYSICIAN’S INITIAL CONCERNS ABOUT SHARING OPEN NOTES More work: Time-consuming to write notes patients can understand & to answer their questions, follow-up calls & s Visits will take longer Medical jargon can confuse patients/will need to change language Potential increase in lawsuits Can create unnecessary stress, worry or anxiety for patients Patients may misinterpret notes without doctor’s input 7Copyright© 2013 Tsoules, Sweeney, Martin & Orr, LLC

8 PATIENTS’ FEEDBACK %Opened at least one note % Felt more in control of their care %Understood health conditions better %Remembered care plan better %Took better care of self %Increased medication adherence % Concerns about privacy 5 - 8%Worried more 2 - 8% Found notes more confusing than helpful 1 - 2% Felt offended (Continued) 8Copyright© 2013 Tsoules, Sweeney, Martin & Orr, LLC

9 PATIENTS’ FEEDBACK 9Copyright© 2013 Tsoules, Sweeney, Martin & Orr, LLC 86 – 89%Open notes are “Somewhat” or “Very Important” factor in choosing a physician 99% Wanted continued access

10 INCREASE IN WORKLOAD? CHANGES IN NOTETAKING? Survey Results %Estimated they had conversations with patients about open notes less than monthly %Reported no or few patients mentioned notes % Reported taking more time writing notes %Changed what they wrote in notes 0 - 8%Spent more time addressing patient questions 0 - 5%Reported longer visits 0%Reported significant changes in volume 10Copyright© 2013 Tsoules, Sweeney, Martin & Orr, LLC

11 INCREASE IN LAWSUITS? Survey Results Improved trust and communication that may ultimately reduce a doctor’s risk of liability “Secrecy, and a sense that the doctor is distant or indifferent, stimulates litigation as much as a free flow of information. If that flow improves trust, the likelihood is fewer lawsuits.” – Michael Meltsner, Esq., in an editorial published with the results of the OpenNotes Project 11Copyright© 2013 Tsoules, Sweeney, Martin & Orr, LLC

12 INCREASE IN LAWSUITS? On the Other Hand: Notes may reveal dormant errors Some errors are minor mistakes, others could be substantial and generate lawsuits 12Copyright© 2013 Tsoules, Sweeney, Martin & Orr, LLC

13 FINDINGS FROM OTHER RECENT STUDIES ON ACCESS TO EMRs Patients with full electronic access to health records and clinical notes were empowered and improved their contributions to care (Journal of Medical Internet Research, March 2013) Patients significantly increased their preventive care after using an “interactive preventive health record” called MyPreventiveCare (Annals of Family Medicine, August 2012) 13Copyright© 2013 Tsoules, Sweeney, Martin & Orr, LLC

14 NEW JERSEY LICENSING LAW N.J.A.C. § 13: Provide access to professional treatment records to a patient or an authorized representative  Authorized representative: A person designated by the patient or court May refuse to provide “the subjective information contained in the professional treatment record” if “in the exercise of professional judgment [the physician] has reason to believe that the patient’s mental or physical condition will be adversely affected upon being made aware of such information” 14Copyright© 2013 Tsoules, Sweeney, Martin & Orr, LLC

15 HIPAA Patients have the right to review or receive a copy of and request electronic access to their complete medical records (including notes) Limited exceptions 15Copyright© 2013 Tsoules, Sweeney, Martin & Orr, LLC

16 HIPAA Access may be denied if: It is likely to endanger the life or physical safety of the patient or another person Records reference another person and access is likely to cause substantial harm to that other person 16Copyright© 2013 Tsoules, Sweeney, Martin & Orr, LLC

17 HIPAA – WHAT MUST BE PROVIDED? An electronic copy of all PHI about the individual in an electronically maintained designated record set  PHI: Individually identifiable health information that is created or received by a provider and relates to the individual’s past, present or future physical or mental health condition, the provision of health care, or the past, present or future payment for the provision of health care  Designated Record Set: Group of records maintained by practice that includes individuals’ medical records and billing records that is used in whole or part by practice to make decisions about individuals 17Copyright© 2013 Tsoules, Sweeney, Martin & Orr, LLC

18 HIPAA – PROXY ACCESS Be sure to have HIPAA-compliant policies and procedures for proxy access to EHRs, including clinical notes Giving caregivers access to complete medical records can medically benefit patients (e.g., elderly patients) 18Copyright© 2013 Tsoules, Sweeney, Martin & Orr, LLC

19 HIPAA OpenNotes Project featured computer-based access, but remember that patients who are not computer-based must still be given access to records and notes 19Copyright© 2013 Tsoules, Sweeney, Martin & Orr, LLC

20 QUESTIONS 20Copyright© 2013 Tsoules, Sweeney, Martin & Orr, LLC


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