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OpenNotes--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
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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
networks?
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?
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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.
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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 content, which 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.
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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.
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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
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In the News
Recent coverage of our work
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Support Our Work
Consumer education and outreach
As you know, Consumer Reports is the only major independent consumer organization
working for transparency in medical costs, effectiveness, and safety. And because we're
free of any commercial influence, we always call it like we see it - never pulling any punches.
Last year, our work on health care helped consumers identify and choose high-quality,
appropriate, cost-effective preventative care, screening/testing, medicines, treatments,
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you have questions.
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