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In a classic “Seinfeld” episode, Elaine Benes learns that her medical chart says she is “difficult” because she refused to wear a paper exam gown. Her efforts to resolve the situation aggravate doctors, leaving her with an untreated rash.

In the real world, where medical charts are increasingly electronic, some providers have started sharing doctor notes with patients. The practice rarely offends patients or burdens doctors, according to researchers with OpenNotes, a national initiative supported by the Robert Wood Johnson Foundation.

In fact, it improves care, the researchers say.

Madison health systems let patients see visit summaries, lab results and other information through the online portal MyChart. But they don’t share doctor notes as do organizations such as Milwaukee-based Columbia St. Mary’s and Rochester, Minnesota-based Mayo Clinic.

The Madison groups could share doctor notes if they wanted to, according to Epic, the Verona-based supplier of the groups’ electronic medical records, or EMRs.

“The technology is there to support it,” Emily Barey, Epic’s director of nursing informatics, said at a panel discussion about EMRs this month at UW-Madison’s Wisconsin Institutes for Discovery.

“You, of course, as the consumer, can ask to have more shared,” Barey said.

The panel was the culmination of a project by Catherine Arnott Smith, a UW-Madison associate professor of library and information studies who specializes in medical informatics. She held town hall meetings in April at public libraries in Appleton, Eau Claire, Platteville and Waukesha about what consumers think about EMRs.

One question that arose: Why are some patients able to see more details of their medical charts than others?

Group Health Cooperative of South Central Wisconsin and Meriter-UnityPoint Health give patients access to much of their medical information, spokeswomen told me.

Dean Clinic — part of SSM Health Care of Wisconsin, which includes St. Mary’s Hospital — plans to make doctor notes available. “The open notes concept is a high priority for Dean Clinic and we plan to begin showing provider notes beginning in 2015,” spokeswoman Kim Sveum said.

UW Health is considering sharing doctor notes, Dr. David Kunstman said. “While it is not in our current project list, I suspect that it will only be a matter of time before we move to this,” he said.

Three large health systems in Boston, Seattle and rural Pennsylvania started sharing doctor notes with patients in 2010. A vast majority of the patients said they felt more in control of their care, better understood their medical issues and better adhered to taking medications, a study found.

Some doctors changed how they wrote notes, especially about sensitive topics such as cancer or mental health. But most said their fears about sharing their notes weren’t realized.

“Doctors reported little effect on their work lives and were surprised by how few patients appeared troubled by what they read,” according to analysis of the findings co-authored by Dr. Tom Delbanco and Jan Walker, co-directors of Boston-based OpenNotes.

At least a dozen other health systems have joined in, according to OpenNotes. Mayo is one of them and will be listed soon, an OpenNotes staff member told me.

No word on whether doctors at any of the health systems have characterized patients as “difficult” for not wearing exam gowns.

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You can reach reporter David Wahlberg at or 608-252-6125.


David Wahlberg is the health and medicine reporter for the Wisconsin State Journal.