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Dr. John SantaOpenNotes--As Good as a Blockbuster Drug, or Better

Consumer Reports has been following the progress of a movement we think deserves your attention and support. At a time when some may not realize there are notes in a medical record about them, OpenNotes seeks to make practitioner's notes easily available. As electronic records become more common and patients use online "portals" to find their health information, it seems especially important to see the notes that show how clinicians are thinking about and organizing one's care. What better way to truly engage and put patients first?

In a year-long pilot program, some 20,000 patients in Boston, Seattle, and rural Pennsylvania were invited to read the notes their doctors wrote following their medical visits. A year later, according to an analysis of the initiative published in 2012, the patients reported impressive results: Eighty-two percent chose to read their notes, and more than 70 percent said that as a result they felt more in charge of their care, understood and took more effective care of their conditions, and did a better job taking their medications. Even though this represented quite a change in practice, doctors were also pleased, reporting little or no difference in their workload and few inappropriate questions or requests due to patients seeing the notes. Although 20 percent had reservations about continuing, when given the chance to turn access off, none did, and four years after the start of the study, these doctors and many others are offering this practice. They must have sensed what consumers were feeling: Ninety-nine percent wanted to continue to have access to notes---including the 18 percent who had decided not to read them.

The Cleveland Clinic, the Mayo Clinic, MD Anderson and the Veterans Administration are now offering their patients ready access to their notes. Many health systems across the country are moving in the direction of OpenNotes.
In April 2014, multiple health systems and large medical groups in Oregon and southwest Washington made a public commitment to provide access to notes in 2014 or 2015, and more than one million patients in that region will have access to notes as a result. Kaiser Northwest implemented OpenNotes on April 8, making notes readily available to 500,000 people if they so choose. As a result, on any weekday in the Kaiser Northwest practices, thousands of people gain access to a new note.

With the Robert Wood Johnson Foundation supporting much of the research and effort to spread this practice, Consumer Reports magazine in December 2013 identified OpenNotes as one of the five most important health advances of the year. And in a JAMA Viewpoint, Jim Guest and Lynn Quincy from Consumer Reports urged that OpenNotes become a "standard of care." At Consumer Reports we are evaluating how we can help OpenNotes move even further into the practice of medicine.

John Santa, M.D

Director, Consumer Reports Health Ratings Center   

June 2014 Newsletter 
In this issue:
What's New
Campaign Updates
Partner Spotlight
Partner Spotlight
Best Buy Drugs Update
In the News
Support Our Work
Quick Links

What's New

Have you seen our new "grassroots" videos? 


Several colleagues on our Health Impact team were talking about Choosing Wisely and 

various topics resonate personally with us or with people we know. On a bit of a 

whim, we decided to record a few of these stories. We intentionally kept them very casual 

and low-key. That's easy to do when we're amateur videographers and our main tool was 

an old iPhone. Our goal is to spur conversation among our friends, families, and 

co-workers -- all of whom are health care consumers.


Would you help us spread the videos widely, through your own professional and personal 



Here are the links.


Do You Need a Chest X-ray Before Surgery?


Antibiotics for Swimmer's Ear


Imaging for Lower Back Pain


What's Wrong with Delivering Your Baby Early?  

Campaign Updates

Health Impact partner meeting


On May 2, almost 100 stakeholders from over 40 national and regional organizations,

all with an interest in the Consumer Reports Health Impact campaigns, gathered in 

Washington, DC for the Consumer Reports Health Conference. This meeting provided 

an opportunity to focus on successes and challenges in promoting and distributing the 

Consumer Reports Health Impact campaign materials to millions of patients and consumers nationwide. "It really was a fantastic opportunity to bring together many of our partners, in 

one place, to share the great work they've been doing and to brainstorm about ways to 

increase our impact even further in the future," said Dominic Lorusso, Director of Health 

Partnerships at Consumer Reports.

Important themes discussed at the conference included reaching the most vulnerable 

and diverse communities; helping patients engage in meaningful conversations with their 

doctors; getting the Choosing Wisely message into consumers' hands at the point of care 

or decision-making; and discussing the best ways to get providers and employees involved. Additional areas discussed for future exploration were improved opportunities for digital 

circulation of materials, modifying materials to meet the needs of local and regional campaigns, 

and defining techniques for reaching various populations of consumers.  


Partner Spotlight 

iTriage embeds Choosing Wisely content


Which tests and procedures are really necessary for patients?  iTriage, a market leader

in consumer health care technology with over 11.5 million app downloads and millions of 

monthly active users, has teamed up with the ABIM Foundation's Choosing Wisely 

program and Consumer Reports Health to help educate consumers about which tests 

and procedures may be unnecessary. 


Patients often struggle to understand whether a test or procedure is necessary, or why 

their doctor recommends it. Choosing Wisely contentwhich is derived from evidence-based recommendations from over fifty medical societies, is embedded in the decision aids 

of the iTriage app to help patients make more informed decisions about their healthcare 

at their time of need. 


For more than five years, iTriage has been a trusted tool for consumers 

asking, 'What could be wrong?' and 'Where can I go for care?' Joining forces on the 

Choosing Wisely education effort helps iTriage further empower patients by prepping 

them with important questions to ask their healthcare provider at the point of care leading 

to more effective shared decision making on their health. Available on iTriage's web and 

mobile apps, the partnership helps millions of active iTriage consumers nationwide better 

manage their health. Providing these decision aids help patients make more informed 

health care decisions, cut down on over-utilization of the healthcare system, and decrease 

waste and patient harm.   

Partner Spotlight  

Choosing Wisely Minnesota campaign receives ICSI's first

PAC Seal of Approval 


The Institute for Clinical Systems Improvement (ICSI) Patient Advisory Council (PAC) 

has awarded its first Seal of Approval to the Choosing Wisely Minnesota campaign. 

The seal signifies that the campaign includes and supports the patient's perspective. 

ICSI formed the PAC to create the criteria against which ICSI would measure the patient-centeredness of its work. The PAC's charter is to champion patient- and family-centered 

care, increase awareness of the patient/family perspective, and encourage shared 

decision-making between clinicians and patients, families and/or caregivers.

In reviewing the Choosing Wisely Minnesota campaign, the PAC members were impressed 

with its physician/patient shared decision-making elements and its patient-friendly materials. 

Receiving the PAC's Seal of Approval signifies that the Minnesota campaign and supportive Consumer Reports materials meet seven criteria: 1) relevance and respect for the patient and 

family; 2) includes family and care givers; 3) supports a coordinated communicating care team; 

4) includes patient concerns in the literature; 5) promotes shared decision-making; 

6) has patient-centered education materials, and 7) includes direct input from patients.

ICSI is a non-profit health care quality improvement organization comprised of 50 medical 

groups and 8,000 physicians, primarily in Minnesota. As an ABIM Foundation grantee, 

it helped launch the Choosing Wisely Minnesota campaign.    

New from Best Buy Drugs 

10 over-the-counter drugs to avoid during pregnancy


Mothers-to-be get headaches and upset stomachs just like everyone else. So it's not 
In fact, some data suggest that, overall, women are actually more likely to use certain 
medications-including cough and cold drugs and acetaminophen (Tylenol, generic)-after 
they become pregnant.

"There's a misperception that if a drug is available over the counter, that it's approved 
by the Food and Drug Administration, so it must be safe for everyone, including pregnant 
women," says Allan Mitchell, M.D. professor of pediatrics and epidemiology at the Boston 
University School of Public Health and Medicine. "Even doctors can fall for this idea.
" But some OTC drugs have been shown to pose risks to the developing fetus at different 
stages of pregnancy.
To help you and your doctor make more informed choices about which medications
to take, we've identified 10 common ingredients used in OTC drugs that are risky
for pregnant women, as well as safer alternatives. Read the article here. 

In the News

Recent coverage of our work   


This article, featuring Dr John Santa in the Los Angeles Times, discusses the overuse of antibiotics and what happens when patients ask for -- or demand -- them.  
This blog in the Wall Street Journal, written by Leah Binder at Leapfrog, talks about the Costs of Unnecessary Medical Treatment. 

Bloomberg Businessweek's story,  Why don't doctors prescribe more weight-loss drugs? links to two of our Best Buy Drugs articles warning against weight loss drugs: "Weight-loss pill Belviq is now available, but we say skip it" and "FDA approves weight loss drug Qsymia, but we say skip it."


Support Our Work

Consumer education and outreach 


As you know, Consumer Reports is the only major independent consumer organization 
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Last year, our work on health care helped consumers identify and choose high-quality, 
appropriate, cost-effective preventative care, screening/testing, medicines, treatments, 
hospitals, and health insurance. We create hundreds of patient-friendly resources 
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