Risks and Benefits of Increasing Patient Access to Clinical Ophthalmology Medical Records Using OpenNotes


The results of this study suggest that the implementation of medical records accessible to patients can be particularly difficult in ophthalmology. The main obstacle seems to be the understanding of the medical file by the patient. Almost 80% of ophthalmic clinicians at the University of Colorado believed that patients would have difficulty interpreting ophthalmic charts. This majority of clinicians is particularly striking when compared to a previous study from the University of Colorado showing that only 14% of cardiology clinicians believed that patients would have difficulty interpreting cardiovascular medical records online. [18]. The perceived decrease in patient understanding could be attributed to factors that make ophthalmic medical records difficult to understand, including their multidimensional nature, complicated and non-standardized abbreviations, and the use of visual drawings and annotations.

Regardless of the source of this perceived barrier to understanding, it is imperative that ophthalmologists strive to reduce this barrier in the age of legally mandatory note sharing that began on 5/4/2021. Patients will read ophthalmologist notes in the future, so it is the responsibility of the ophthalmologist community to strive to make their notes understandable to patients and fellow clinicians without a dictionary of abbreviations at hand. Technology can be helpful in this process, as with electronic medical record systems approaching universal adoption, ophthalmic abbreviation machine translation tools are expected to become more widely available and used routinely.

While this study corroborates previous research by indicating the potential of OpenNotes to improve clinician-patient communication, patient adherence and patient empowerment, it is not known how these benefits will manifest in ophthalmology given the important barrier of understanding. Additionally, clinicians interviewed saw various potential drawbacks to sharing medical records with patients, including increased confusion, worry and stress in patients, increased workload for clinicians, and a change in the way that clinicians document encounters, potentially jeopardizing the integrity and usefulness of medical records. Although these concerns were echoed by clinicians in other departments, the percentage of clinicians who feared these negative consequences was higher in ophthalmology, suggesting that ophthalmology is distinct from other specialties with regard to implementation. medical records accessible to patients.

Several perceptions surrounding physician-patient relationships were associated with ideas about increasing the accessibility of medical records. Clinicians who viewed patient-physician arguments as signs of mistrust saw more benefit from sharing notes; they were much less likely to worry about their increased caseload and more likely to believe that patients would be better prepared for visits and better understand their medical conditions and instructions. In contrast, there was a correlation between physicians thinking that the physician should always be responsible and physicians seeing the negative consequences of sharing notes. Those who thought they should be responsible were much more concerned that patients would be offended by the content of the notes. These correlations suggest that physicians’ perceptions of the physician-patient relationship and perceptions of patient access to medical records are closely linked. Changing access to patient medical records could alter the clinician-patient relationship, an important pillar of clinical ophthalmology.

This study is mainly limited by the small sample size, which limits the statistical power. Additionally, since this study only sampled the perceptions of clinicians, not patients, it was unable to assess some potential benefits and risks that sharing notes might have in ophthalmology. The views of clinicians and patients on whether patients should have access to medical records are often conflicting; it is imperative to understand not only where these perspectives diverge, but why.

Importantly, the beliefs assessed in this study were recorded in 2016, before clinicians started using OpenNotes. Ideally, perceptions regarding OpenNotes would be assessed before and after its implementation, but that was not feasible here. If you are questioned after using OpenNotes, it is likely that some ophthalmologists’ concerns would be assuaged, while others could be magnified. In 2021, after 5 years of using OpenNotes, the clinical management of the University of Colorado reports that no significant concerns were raised by patients despite the fears of ophthalmologists interviewed in 2016 before the implementation of ‘OpenNotes (Chen-Tan Lin, MD, e-mail communication, June 2021). Future studies should assess patients’ understanding of online ophthalmic records and examine how perceptions of note sharing change once ophthalmologists become accustomed to the records accessible to patients. A growing body of literature indicates that after implementing OpenNotes, clinicians generally view score sharing as a net positive [1, 20,21,22], but it is important that this question be explored specifically in the field of ophthalmology.

Despite its limitations, this study offers important insight into how increasing patient access to medical records may affect healthcare delivery and physician-patient relationships. By identifying the provider’s perceived risks and benefits of providing patients with access to online ophthalmic records, this study lays the groundwork for a future investigation into how such unprecedented access can impact the patient relationship. – doctor, patient confidence, clinical results and ophthalmologist’s practice. Finally, this study suggests that ophthalmic clinicians may have fears and concerns regarding the implementation of OpenNotes that differ significantly from those of other clinicians. As such, healthcare systems implementing OpenNotes should recognize the unique challenges of note sharing in ophthalmology, educate ophthalmology providers on the benefits of note sharing, and collaborate with these providers to work on it. aim to make the notes more understandable for patients.

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