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  • Open notes

    Office and hospital notes must be made available to patients starting Nov 2nd.

    This is going to generate a lot of phone calls.
    A new federal rule will soon require patients be provided access to all of the health information in their electronic medical records beginning November 2, 2020. The federal rule is a result of the 21st Century Cures Act, which was passed by Congress in 2016. OpenNotes is invested in the Cures Act because clinical notes are among the information that must be shared with patients.

  • #2
    Originally posted by Lordosis View Post
    Office and hospital notes must be made available to patients starting Nov 2nd.

    This is going to generate a lot of phone calls.
    Is there a law that mandates returning all phone calls?

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    • #3
      We have had this in the VA for years. It’s fine.

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      • #4
        Originally posted by Anne View Post
        We have had this in the VA for years. It’s fine.
        Good to know.
        I can think of a few patients who will cause the majority of the issues. But that is usually the way it is.

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        • #5
          Originally posted by Lordosis View Post

          Good to know.
          I can think of a few patients who will cause the majority of the issues. But that is usually the way it is.
          Correct. And they would have just found another reason to create trouble anyway

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          • #6
            Originally posted by Lordosis View Post
            Office and hospital notes must be made available to patients starting Nov 2nd.

            This is going to generate a lot of phone calls.
            kaiser has done this for years i believe.

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            • #7
              VA did open notes years ago when I was there -- ~2010 IIRC - initial small bump of inquiries but that went away
              We did Open notes about three years ago in our system and same consternation from the docs about their notes.

              Key point - don't be putting offensive stuff in your notes, and reasonable patients will be reasonable. Some may question the validity of the documentation and rightfully so in many cases the patient is right on calling it out.

              The ones that we typically worry about---are the ones already requesting notes through medical records and audits anyways.

              The bump is small just curious folk; but pewters out quickly.

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              • #8
                Good reason to stick with paper charts!

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                • #9
                  If you're concerned about malingering or drug seeking, but it's only in your doctor "spidey sense," how does one document this and not create red flags? I'm sure there are some squirrely patients who are just odd and not drug seeking, but others that do warrant some sort of documentation. Also, I'm sure there needs to be some number of visits where they display behavior that would be drug seeking/malingering before you can fire them without ending up in a court for abandonment or something of the sort.

                  I don't know if this will encourage or discourage "plain language" in notes.

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                  • #10
                    What about all of the extremely detailed review of systems and physical exam templates that people use.

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                    • #11
                      We instituted Open Note about 3 years ago. Had one patient refuted info in the note. I just put an addendum at the bottom of that note, "Pt called in to state they had 4 days of cough rather than 3."

                      I was told that about 16 of my patient had read my notes all these 3 years. Was scared of Open Note in the beginning but it is truly fine (knock on wood).

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                      • #12
                        they've beaten it out of me. "obese but otherwise well appearing" "strong odor of tobacco" "odor of alcohol in the room" "abdomen is obese" etc have not shown up in my note for some time. rare, but any complaint is not worth the time of chart objectivity: the customer is always right... "nope that gown doesn't make you look fat...the XXL is actually mislabeled as a medium, so don't be alarmed." Lordosis, thanks for another reminder of why I hate my job.

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                        • #13
                          Originally posted by fatlittlepig View Post
                          What about all of the extremely detailed review of systems and physical exam templates that people use.
                          This. Coming to the US from Canada, the physical exam templates don’t pass the sniff test. Gamesmanship. ROS is fine, staff reviews it. But, this is how the system is set up. I know a doctor who was billed a level 4 visit for a covid test. Just the test. He laughed.

                          I was in a setting where I could ignore putting in all the fake stuff in physical exam until recently. Struggling with being told “if you add more systems you can bill higher!” with no insight from the coding folks that providers are just bsing good chunks of their exams. I take care of bones. The value of me listening to the heart is pretty much zero and documenting that I did is garbage.

                          Patients will see that stuff and the medical profession will lose more credibility.

                          As of January, MDM will dictate level of visit. This is a step in the right direction, but I worry it’ll result in an uptick of unnecessary tests given the “point” structure.

                          Wandered off topic. Of course patients should be able to have their notes.

                          Comment


                          • #14
                            I’m pretty direct but kind with people and try to be objective in my documentation. If someone is obese or drinks a lot or whatever and it impacts the condition I’m seeing them for, i talk with them about it. I don’t say “hey fatty you’re obese why don’t you lose some weight so your knees don’t hurt as much?” No I say “what do you think of your weight?” Usually they know they are obese and how it’s impacting them even if they aren’t doing anything about it. If they don’t think they are obese, I might say something to the effect of, your BMI is 32 which is defined as obese...and then we discuss from there. And I document that discussion. We talk about smoking, alcohol use, etc. If someone tells me they don’t smoke but they reek of cigarettes I’ll say “your shirt really smells like cigarette smoke” nonjudgmentally/nonconfrontationally and sometimes they’ll be like oh yeah my spouse smokes or sometimes they’ll admit that they actually do smoke. If I think someone is drug seeking I will discuss with them specifically why I don’t recommend the drugs they are seeking and offer alternatives, and let them accept or decline. If I think someone is malingering I empathize with them regarding their symptoms and discuss with them how I can not find any explanation on their exam and other workup. And I document all this, as concisely as possible. Maybe it’s my patient population, maybe it’s my personality, but I document what I’m thinking, let the patient also know what I’m thinking, and knock on wood it’s been just fine. The few times I have had inquiries/complaints I let them know that I must document my medical opinion and recommendations, and what is documented is just that.

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                            • #15
                              Go ahead and change all your templates to begin with "This is a very charming, delightful gentleman whose intelligence is rivaled only by his handsomeness."

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