Initially, the answer seems simple: an open note platform would increase accuracy and completeness of EHR data. Two eyes on the same set of data is better than one. Clinicians could cross collaborate with their patients and double check information (OpenNotes, n.d.). After all, patients know more about their own health than anyone else. However, it’s not so clear that open notes are without problems.
One problem is in pediatrics where the pediatrician, the parent, and the child often share access to the information (Bourgeois et al., 2018). The information may concern things like reproductive health or substance abuse which would be ethically challenging to talk about. For example, an adolescent may seek care for STD’s without their parents’ consent. Depending on organizational policies, a parent inquiring about the visit may know that the visit is confidential or partly confidential which could create a precarious situation for the patient. An adolescent may be put in a situation where they don’t want to disclose too much information about their health if they know that a parent will look over the notes.
In another study with VA mental health clinicians, many felt that their open notes were less detailed and that the tone of their notes had changed (Dobscha et al., 2016). They felt that many patients would find errors in their notes and might ask them to change it. Patients would also worry more about their condition when overlooking their notes creating more stress for both the patient and the clinician.
Having open notes creates a kind of Panopticon Effect on clinicians who have to think about the people who are looking over what they write. It can create unease in the way that clinicians prepare their notes. Overall, it should create more accuracy because they know that many eyes are looking over their shoulder.
References
Bourgeois, F. C., DesRoches, C. M., Bell, S. K. (2018). Ethical Challenges Raised by OpenNotes for Pediatric and Adolescent Patients. Pediatrics, 141(6), e20172745-7.
Dobscha, S. K., Denneson, L. M., Jacobson, L. E., Williams, H. B., Cromer, R., & Woods, S. (2016). VA mental health clinician experiences and attitudes toward OpenNotes. General hospital psychiatry, 38, 89-93.
OpenNotes. (n.d.). OpenNotes – Patients and clinicians on the same page. Retrieved May 22, 2020, from https://www.opennotes.org/