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Curbside Consult with Dr. Jayne 10/19/20

October 19, 2020 Dr. Jayne 1 Comment

There has been a tremendous amount of anxiety in the virtual physician lounge this week. One of the local hospital systems announced that they are going to start releasing all physician notes to patients via their MyChart implementation. Apparently, there was very little information provided about how confidential information will be addressed, particularly among teenagers, and physicians are concerned about the repercussions.

I’ve been watching the conversations, trying to get a feel for how the situation looks to physicians who aren’t informaticists and don’t have a full understanding of why this is happening. Some of the comments underscore the need for education and highlight the opportunity that hospitals have to make sure their medical staff members are all on the same page and understand the background:

  • Why are all the hospitals jumping on this bandwagon? Seems like just another patient engagement trend.
  • It’s an absolute mandate from CMS.
  • It’s a Medicare thing. I’m just going to do my Medicare patient notes on paper and scan them in.
  • I’m going to make a smart phrase now to explain that I’m no longer using MyChart.
  • Patient notes are for me and my colleagues, not for the patient.
  • This contradicts state law, I’m not doing it.
  • I’m just going to make my notes very sterile, generic, and useless in order to avoid patients freaking out about things they don’t have the training to understand.
  • There’s a $1 million fine if you don’t do it.
  • X health system has an option to “not share the note.” I assume this is going away.
  • Y health system just implemented an option to “not share,” I guess this is due to the new requirement.
  • No patient ever needs to see the back and forth messages between my staff and me, whether it’s in their chart or not.
  • I’m just going to make shadow charts on all my patients.
  • I hope they take this into account with the patient satisfaction surveys. Patients are going to hate seeing the real truth about themselves.

To be honest, I was surprised by how bitter and angry some of the comments were. It made me a bit embarrassed to be part of the physician community in my area.

At least there were a couple of physicians who chimed in who had previous experience with OpenNotes, trying to reassure people that it won’t be as bad as they are anticipating. Another pointed out a positive experience with patients who claim they were never advised of various parts of the treatment plan, but it was clearly documented in the notes they received after the visit, which led to some good discussions with patients who could benefit from taking charge of their health.

It was a very different conversation than the one going on among my clinical informaticist peers, who have been detailing their plans in various informatics forums. It sounds like there is a strong consensus on only releasing ambulatory notes and test results after they have been signed by the responsible physician, and only releasing inpatient documents after discharge, but that’s where the consensus ends. However, there has been some good discussion around the fact that the regulations are somewhat vague and it’s not clear whether “progress notes” includes all progress notes (such as nursing, physical / occupational / speech therapy, social work, etc.) or just physician notes.

Some health systems are running full speed ahead for a November 1 go live, but others seem to be biding their time hoping that there will be a delay in enforcement. Although I see the value of patients having access to their notes, most health organizations are pretty strapped right now, what with the pandemic and all. Many of my independent physician friends are barely keeping their heads above water, with another one deciding to retire at the end of the calendar year. I think there are quite a few of them who wish that a health system would acquire them, but it doesn’t seem like there’s a lot of available cash for practice purchases these days.

How is your organization preparing for the upcoming mandate? Do you think your physicians understand what it’s all about? Leave a comment or email me.

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Currently there is "1 comment" on this Article:

  1. 21st Century Cures Act has been a all-hands-on-deck issue for us for the past couple of months. We were already in a good place interoperability-wise and the deadline was a good excuse to review all our data-sharing policies and settings in our system. Since in Massachusetts, children are considered medically emancipated at 12, we have had to review our proxy settings and our patient portal setup in general. As far as our providers go, they have been complaining about the notes transparency and results release changes that the Cures Act brings with it. Unfortunately a mandate is a mandate so there is not much anyone can do to push back against the impending regulation. If you don’t like the law, don’t complain–vote!

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