Sept / Oct 2022 | michigan MEDICINE® 13 Fans of the hit 1990s sitcom, Seinfeld, regularly say its brilliance and success came from its ability to point out the humor in the events of our everyday lives. In 1996, just after the Health Insurance Portability and Accountability Act (HIPAA) was enacted, character Elaine Benes takes a sneak peek at her medical chart while her doctor is out of the room to find that someone had written she was “difficult” after a previous a visit. Elaine confronts her physician, Doctor Stern, and pleads her case trying to explain why she wasn’t being difficult when she refused to wear a gown at the appointment four years previous. “I wore a tank top,” she says. “Specifically so I wouldn’t have to wear a gown. Cause, you know, they’re made of paper.” Her doctor smiles and nods. “Well, that was a long time ago. Why don’t I just erase it,” he says as he takes his pencil eraser to her chart. “But it was in pen,” Elaine says. “You fake erased.” Doctor Stern takes his pencil and writes in her chart, but doesn’t allow her to see it. She transfers physicians, and makes attempts to steal her chart at the new practice to see their comments about her. But she never succeeds in getting ahold of her patient notes. Elaine would have appreciated the Information Blocking Rule of the 21st Century Cures Act. Old practice, new caveats Providing patients access to visit summaries is nothing new. Engaging patients not just during their visit, but immediately following it, is more likely to improve health outcomes by encouraging them to take an active role in follow-up care and monitor any issues identified. In fact, according to one study, many patients immediately forgot about half of the information communicated during an appointment. Forty-nine percent of decisions and recommendations were recalled accurately without prompting; 36 percent recalled with a prompt; 15 percent were recalled erroneously or not at all.1 Recently, the final rule on Interoperability, Information Blocking, and ONC Health IT Certification (“Information Blocking Rule”), part of the 21st Century Cures Act, nationally mandates that patients be granted access to all of the information in their medical records, electronically and without charge or delay, and through patient portals or, to the extent possible, through thirdparty smartphone applications (apps). In particular, the requirement stating that patients must be able to access information in their electronic health records “without delay” has raised many questions pertaining to physician note taking and practice management. You may find yourself asking: Does a patient really get access to all of the information I record about them? How much extra time will this require of me? What if a patient takes issue with how I say something? What if they don’t understand a clinical summary or have questions about lab results, etc.? In fact, however, there are many valuable note taking strategies that support transparency, quality, and—most of all—improved patient outcomes. Transparency builds trust According to MSMS Legal Counsel, Kathleen Westphal of Kerr, Russell & Weber, the increased transparency afforded under the Information Blocking Rule aligns well with the Open Notes concept. “Initially, there were questions about logistics and concerns regarding how compliance with the Information Blocking rule will impact a physician’s practice,” says Westphal. “Over time, we’re seeing that with increased transparency with patient notes, there is more opportunity for improved communication regarding a patient’s treatment, better engagement by patients, and an overall strengthening of the physician-patient relationship. This generally leads to fewer complaints and better outcomes.” Some physicians worry that the direct tone of their notetaking, or recording sensitive subjects, such as patients not following care instructions, will offend. Others worry that the clinical nature of their notes will be inaccessible, misconstrued, or lead to further worries about Does allowing patients quick and easy access to the information in their medical record improve patient care? Yes— but simple adjustments can maximize the benefits of full information sharing. (CONTINUED ON PAGE 14)
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