Impact of Electronic Access to Physician Notes on Oncology Patients: A Prospective Evaluation

Abstract

There is an increasing effort to allow patients access to physician notes through electronic health record (EHR) portals. However, the impact of such access on oncology patients has not been specifically evaluated, and there are concerns regarding potential harms. To further guide the implementation of electronic access to physician notes in oncology, we prospectively determined the impact of these notes on patients receiving radiation therapy. Between July and December 2017, 300 patients were invited to participate at their initial radiation oncology evaluation. Patients were given instructions on how to access their physician notes through the EHR portal and a baseline survey to assess their interest and expectations of these notes. A final survey at the end of radiation treatment was given to determine actual usage and the impact of physician notes on oncologic care. The response rate was 44% (133/300) to the baseline survey and 63% (84/133) to the final survey. The majority of participants (61%) were 60 years of age or older and 48% were female. 98% of participants had not previously read their physician notes. On the baseline survey, 94% of patients agreed that they would feel in better control of their cancer care if they read their physician notes, 96% agreed they would feel more reassured about their treatment, 98% agreed they would better understand treatment side effects, 86% agreed they would have less need to contact their physician, 22% agreed they would worry more about their diagnosis, 16% agreed they would have more confusion, 13% agreed they would have privacy concerns, and 13% agreed they would find information they would regret reading. In total, 88% of participants selected that they planned to electronically access their physician notes. Significantly fewer patients (57%) actually read their physician notes vs. those planning on accessing their notes (p<0.001). The most common reasons for not accessing notes included already having enough information (63%) and technical difficulty (14%). All patients who accessed their notes agreed they were useful. Additionally, 94% felt in better control of their care, 98% were more reassured about their treatment, 96% better understood treatment side effects, 85% had less need to contact their physician, 12% worried more about their diagnosis, 6% had more confusion, 4% had privacy concerns, and 4% found information they regretted reading. Oncology patients have a strong baseline interest in electronically accessing their physician notes and mostly expect these notes to positively impact their care. After reading physician notes, patients overwhelmingly noted improvements in their cancer care experience with only a minority of patients reporting concerns. These data support the continued implementation of strategies to allow oncology patients electronic access to their physician notes.