China
Africa
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The Patient Empowerment Movement
Published in Disa Lee Choun, Anca Petre, Digital Health and Patient Data, 2023
Another empowering digital service is the availability of electronic health records (EHR) directly to patients through patient portals. Many countries are heavily investing in creating EHRs, driven by new legislation or regulatory frameworks, as we will further discuss in Chapter 4. In 2019, in the US, more than 95% of hospitals were equipped with an EHR.31 Making these records accessible to patients provides them with comprehensive information about their health through discharge summaries, notes, or lab tests. Movements such as OpenNotes32 promote greater sharing and transparency between health professionals and patients on medical notes which is critical to ensure accuracy and build trust. Patient access to their medical records was found to have a multitude of positive outcomes from improving medication adherence, to creating more trust in the medical community, to reducing hospitalizations.33 Countries such as France or the UK have already shared initiatives to make medical records accessible to patients to increase transparency and promote individual responsibility that should help to achieve a more efficient health system.
Patient–Professional Communication
Published in Richard J. Holden, Rupa S. Valdez, The Patient Factor, 2021
Onur Asan, Bradley H. Crotty, Avishek Choudhury
The use of the second EHR screen is similar to the concept of transparency and “nothing about me without me” that has been the mantra of the OpenNotes concept. OpenNotes is a movement to enable patients to read their clinicians’ progress notes, which include information about the history, examination, and clinician’s assessment and plan (Bell et al., 2015). The concept was initially tested on a wide scale in 2011. In the OpenNotes study, 13,000 patients received access to their notes across three hospitals. The findings showed that patients valued access to their notes far above the expectations of their clinicians, suggesting that clinicians may take data for granted but patients increasingly are seeing direct access as valuable. It is therefore unsurprising that patients also valued the ability to see clinicians create their notes in real time. Also similar to OpenNotes is the concept that clinicians are developing trust in their patients. The future of OpenNotes is shared note creation among patients and clinicians. The second screen may facilitate such future endeavors. However, patient literacy levels, including health and computer literacy specifically, likely will impact benefits experienced by patients (Asan et al., 2014, 2015).
Personal Health Engagement
Published in Salvatore Volpe, Health Informatics, 2022
One of the initiatives that has shown success in getting people to use their online portals is the open notes initiative, which provides patients with access to their physician’s notes. Although the uptake rates on patients invited to view their notes were not significantly different than portal uptake in general, open notes seemed to be particularly useful in helping underserved populations take control of their health. A study exploring these issues looked at six potential benefits from patients reading their notes: feeling in control, preparing for visits, remembering the plan of care, taking care of health, making the most of visits, and having an active role. They reported the following outcomes: Black patients were more likely than white patients to rate note reading as very important for 5 of the 6 benefits and patients aged 45 years or older rated it very important for 4 of the benefits compared with those aged 18 to 24 years. Those who usually spoke a language other than English at home were more likely than English speakers to use notes to make the most of visits, remember the plan of care, and prepare for visits. Patients with the fewest years of education and Hispanic patients were more likely than others to cite note reading as very important for remembering the care plan and preparing for visits. Patients who read a greater number of notes were more likely to cite reading notes as very important for all 6 benefits.20People also use wearable devices, smartphone applications, and social media to engage with their health outside of the constraints of the healthcare system. A Gallup poll conducted in November of 2019 showed that about a third of Americans have used a fitness tracker or mobile app to track their health now or in the past. In the same survey, about 75% of current or past users of wearable fitness trackers found them very (30%) or somewhat helpful (46%). About 82% of those who used health apps found them very (29%) or somewhat helpful (53%).21 The poll also found that adults under 55 were almost twice as likely to have used digital health tools as adults aged 55 and older.
‘We are on the same page:' the importance of doctors EHR screen sharing for promoting shared information and collaborative decision-making
Published in Journal of Communication in Healthcare, 2020
Lyn M. Van Swol, Miranda Kolb, Onur Asan
One problem with screen sharing is that patients may see information that the doctor does not necessarily want the patient to see or that may be misunderstood by the patient (e. g., patient interrupting the word ‘tumor’ as cancerous, when it may have a much more benign meaning in the EHR). Doctors mentioned that patients would sometimes challenge negative information in the EHR, like a diagnosis of obese. Asan and Montague [44] suggest that many of these concerns can be addressed through display designs. One solution they offer is to have patient view a pared down version of the EHR that omits what the doctor does not want the patient to see. Asan et al. [51] suggest that there should be two screens in doctor’s office, so that the patient can see a display that is simpler and more appropriate. As open notes become more prevalent, doctors are changing their noting style, avoiding terms like drug seeker. Still, these could be opportunities for doctors to discuss and educate the patients more regarding the issue.
Should the Clinical Ethicist Document Her Complicity in Intentional Deception?
Published in The American Journal of Bioethics, 2021
Only hours after the Code Conference, and under the auspices of “Open Notes,”16 she had accessed the doctor’s notes, which she found somewhat vague. At the time, she had been reassured by the CEC’s postconference note documenting the sense of the conference—that the daughter’s wishes regarding CPR would be respected, but omitting mention of having blessed the agreed-upon Do Not Attempt Resuscitation (DNAR) order.