|
 For the study, researchers interviewed 29 physicians, nurses,
patient advocates and computer experts about the potential benefits
and pitfalls of letting patients directly contribute to doctors’
notes. The interviews focused on OurNotes, a platform that lets
patients co-produce medical notes with clinicians.
Overall, people expressed mixed feelings. These contributions could
improve care, make checkups more efficient and save physicians time,
participants said. But it’s also possible that reviewing what
patients add to the notes could encroach on doctors' already scarce
time without making care any better.
“Broadly speaking, OurNotes is an open acknowledgement that
healthcare (particularly chronic disease healthcare) is continuous,
requiring full-time engagement and not completely determined by
15-minute visits 2 to 4 times per year,” said lead study author Dr.
John Mafi, a primary care physician at the David Geffen School of
Medicine at the University of California, Los Angeles.
“OurNotes has the potential to improve care directly by allowing
patients and families to set their agenda ahead of time and update
their past history, potentially saving time during the actual
encounter and allowing for a more accurate medical history,” Mafi
said by email.
“If not executed thoughtfully, it may unintentionally add workflow
to busy clinicians who have to review lengthy non-relevant patient
data, and adding to busy clinicians’ workflow is a nonstarter,” Mafi
added.
Overall, participants were most supportive of the idea of asking
patients to review records and contribute new information before
upcoming appointments, researchers report online November 13 in
Annals of Internal Medicine.
Keeping these contributions structured and limited in length would
help empower patients to provide critical information without
creating a huge burden on providers to sift through an overly
detailed account of unessential information, the interviews found.
Many participants, however, thought it might not be realistic to get
patients to do this work on their own time, outside the context of
an office visit.
Some patients might be intimidated by the technology or the nature
of the questions, or both. And some patients simply might not want
to contribute to their records, preferring to discuss their health
with clinicians in person.
[to top of second column] |
Patient contributions would also only be helpful if reading and
responding to this information didn’t interrupt clinicians' workflow
or create extra work.
Beyond its small size, another limitation of the study is its
non-random selection of participants and its lack of direct patient
participation, the authors note.
Still, researchers are continuing to test OurNotes in several
settings; for example, to get input from patients before primary
care checkups.
“One upside could be making patients feel like doctors value their
perspective, which isn’t always the case now,” said Dr. Monika
Safford, author of an accompanying editorial and chief of general
internal medicine at NewYork-Presbyterian/Weill Cornell Medical
Center in New York City.
“A lot of patients don’t understand a word the doctor says and are
too afraid to challenge them with questions,” Safford said by email.
“This is especially true for the elderly and minorities.”
Currently, patients don’t always prepare questions or complete
paperwork before appointments even when doctors ask for this, and
physicians may also fail to read any information patients do
provide, Safford added.
“So everyone is not on the same page, so to speak, at the current
time,” Safford said. “Allowing patients to enter their (recent)
history and concerns would standardize this process and could
possibly increase the number of patients who feel truly engaged in
their care.”
SOURCES: http://bit.ly/2AE5HKW and http://bit.ly/2zUuTjJ
Ann Intern Med 2017
[© 2017 Thomson Reuters. All rights
reserved.] Copyright 2017 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed. |
