One of the more interesting trends in healthcare in recent years is the opening up of patient notes so that patients can both access them, and in some instances edit them too.

Generally speaking, I think this is a great thing, as a Harvard study from last summer showed.  When given the chance to access their notes, 85 percent of those in the study did so, with a range of beneficial outcomes.

Some, for instance, used the notes to spur changes in lifestyle and behavior.  Others reported that reading their notes gave them a feeling of greater control over their care, whilst those prescribed drugs felt the notes were helpful in the correct application of those drugs.

What’s more, nearly half of patients shared their notes with others, especially with spouses or family members.  The project also proved popular with doctors, and overcame their initial fears that it would be time consuming.

Such was the impact that 99 percent of those people wished to retain access to their notes if possible.

Unintended consequences

All of which seems to provide unequivocal evidence for doing so.  Alas, a recent study from Northwestern University highlights some potential pitfalls of more widespread transparency of medical notes.

The study suggests that the kind of portals by which patients can access their medical records may actually widen the gap in health disparities among vulnerable patients.

The paper reveals that patients with low health literacy and education were significantly less likely to utilize such portals, therefore they lose out on the many benefits such sites afford them, whether that’s easier prescriptions, securing lab results or even simply engaging with their doctor.

“Patient portals that offer access to electronic medical records could help individuals better manage their health care and personal needs, but people with less access to and comfort with computers are at risk of not receiving these benefits and will eventually be left behind,” the author says.

“It’s a big concern as the patients that already are, perhaps, less engaged in their health and experiencing worse health outcomes may be further marginalized,” they continue.

It emerged that white patients were 2.5 times more likely to be registered on an online portal than African American patients.  What’s more, patients with high health literacy scores were 3.5 times as likely to be registered as those with lower scores.

The paper highlights the risks involved in assuming that all patients are equipped to use new methods.  It may result in them experiencing delays in information or guidance about their health, and indeed their doctors may become less informed about their wellbeing.

They suggest that currently underserved populations may, therefore, need additional support to ensure they fully utilize the tools available to them, both in signing up in the first place and then in regular usage.