{"id":6923,"date":"2010-08-08T09:55:13","date_gmt":"2010-08-08T14:55:13","guid":{"rendered":"http:\/\/pmedicine.org\/epatients\/?p=6923"},"modified":"2010-08-08T09:55:52","modified_gmt":"2010-08-08T14:55:52","slug":"reflections-after-a-specialist-visit-without-opennotes","status":"publish","type":"post","link":"https:\/\/participatorymedicine.org\/epatients\/2010\/08\/reflections-after-a-specialist-visit-without-opennotes.html","title":{"rendered":"Reflections after a specialist visit *without* OpenNotes"},"content":{"rendered":"

\"\"<\/a>Next in our series<\/a> on my experience with OpenNotes, a project sponsored by the Robert Wood Johnson Foundation’s Pioneer Portfolio.<\/em><\/p>\n

This item has nothing to do with OpenNotes itself – it’s what I’m seeing now that I’ve started <\/em>accessing my doctor’s notes. In short, I see the clinical impact of not <\/em>viewing my record as a shared working document.<\/p>\n

Here’s the story.\u00a0
\n______<\/p>\n

In OpenNotes, patient participants can see the visit notes their primary physicians entered. Note – primary, not specialists. I imagine they needed to keep the study design simple.<\/p>\n

So, here I am in the study, going through life. Five weeks ago I wrote my first realization<\/a>: after the visit I’d forgotten something, so I logged in. There it was:<\/p>\n

IMPRESSION AND PLAN: …<\/p>\n

3. Dermatologic. I think this is actinic keratosis and needs to be removed. Refer to dermatology.<\/p><\/blockquote>\n

I’d reported a crusty lesion on my forehead at the hairline. I’d had the same kind of lesion last year, and the dermatologist had frozen it off. (I have a history of skin cancer.) This time, the need to handle it had slipped my\u00a0(ever slippery) mind.<\/p>\n

Several weeks had already gone by so I emailed Dr. Sands (in the PatientSite secure portal) asking if I should insist on a fast appointment. He said no.<\/p>\n

Notice that all this happened without any phone calls<\/em>, because I could do it online. And that means it all happened sooner (act in the moment, no phone tag). And it captured the action in the moment when I thought of it.<\/p>\n

[These are all well known advantages of being online – in other industries, but still debated in healthcare, sigh. How can an industry founded in science ignore evidence from other industries?]<\/em><\/p>\n

Last Wednesday I saw the specialist. On my way out I found myself expecting that I’d go home and update the notes in PatientSite. Then I realized I can’t – because at present the visit notes are read-only.<\/p>\n

More to the point, today the visit notes are an unstructured blob of text. I realized:<\/p>\n