How Families and Caregivers Can Use Open Notes
Manage your child’s health care. Open notes provide the ability to access your child’s visit notes wherever and whenever you want to remind yourself and your child what was discussed during an office visit. Reviewing the record and the notes can help make sure that everyone understands the treatment plan and is on the same page with the care team for next steps.
“My husband calls me the Chief Operating Officer of our family. With three kids, each with different schedules and different health concerns, access to the notes is a tremendously valuable tool to help me manage our health.”
Communicate concerns. Reviewing the notes is important for several reasons. Some families and care partners may help identify possible mistakes in the note, and can help improve note accuracy by sharing these with their health care team. It is also important to let the care team know if you and your child don’t understand the care plan, or are unable to follow the recommended next steps after reading the note.
Share notes with others involved in care. Schools often ask parents to fill out a health form at the beginning of each year. It can include a vaccination record or a description, for example, of how a child’s asthma is managed. Accessing your child’s medical record can not only help you recall important details, but it also allows you to share portions of the notes with the school nurse, another health specialist, or to anyone you choose to give a more detailed description of a condition or treatment plan.
Help children learn to navigate the health system. OpenNotes can help parents help their children, especially those with complex health concerns, feel empowered and more in control of their health. Reading notes can also help patients and families develop skills to become even more informed users of the health system going forward.
Which Health Systems Share Adolescent Notes as Well as Pediatric Notes?
Many health systems share pediatric notes. The following systems share adolescent notes as well:
“Our approach to sharing notes with adolescent patients was brought to us by our family physicians, who felt that we should not withhold portal access from these young people. Using our decision-making standard ‘what is the best thing for the patient?,’ we felt that in this age group especially, digital tools were likely to be important in developing responsible, engaged patients who partnered with their clinicians.”
— Marcia J. Sparling, MD, Medical Director for Informatics, The Vancouver Clinic
FAQs for Families & Caregivers
What is a note?
After a visit or any discussion with you and your child, the clinician writes a note summarizing the most important information discussed, for example details you or your child provide about symptoms, a description of the exam, an overview of lab results, and details about the treatment plan and next steps. All of this becomes a part of your child’s medical record.
What is OpenNotes?
OpenNotes is an international movement encouraging clinicians to offer patients, parents and their care partners ready access to the health care notes doctors, nurses and other clinicians write after a clinical appointment or discussion. Making notes open helps patients or parents to read material that, through the federal Health Insurance Portability and Accountability Act (HIPAA), is already theirs to receive and review, if they so desire.
Where can I read my child’s notes?
Parents can access their child’s medical records using the health care system’s secure, patient website or portal or by requesting a paper copy. By creating a secure, online account on the web portal, parents and care partners can request appointments, communicate with the health care team and view portions of your child’s health record, including the notes, in systems that have OpenNotes. Parents can sign into the portal – at their convenience – using an Internet enabled computer or smartphone. If the child’s doctor or nurse does not use a web portal, parents can ask for the notes to be printed.
How do open notes affect confidentiality and privacy?
All clinicians involved in your child’s care already have access to the information contained in the medical record. Doctors, nurses and all health care professionals operate under strict confidentiality rules, and open notes do not change that relationship, though parents and care partners can choose to share medical information with others involved in a child’s care. This collaborative approach ensures that patients and specialists are well-informed on treatments and progress, a vital consideration for patients with multiple specialists.
To help ensure your privacy, keep your login name and password private, and whenever you look at your child’s health record, always remember to sign out.
How is confidentiality affected when children become adolescents?
Laws defining the types of health care services and minimum ages at which adolescents may independently seek those “confidential” services differ from state to state. It’s important to discuss access to health information with your adolescent and the care team. At Boston Children’s Hospital, adolescents can create their own accounts to access their health information without parental consent, but cannot view secure messages sent between the parent/guardian and the health care team. Parents/guardians cannot view secure messages between the adolescent and the health care team, confidential appointments, or confidential health information. Confidential information may include: confidential laboratory results, confidential diagnostic studies reports, visit notes that may include confidential/sensitive information, and confidential problems and medications.
“We believe it’s important to allow parents access to their adolescent child’s non-confidential medical information, as many parents continue to play an important role in helping adolescents assume responsibility for their medical care guiding them through healthcare decisions.” Endless space 2 population control.
Pediatrics Books For Medical Students
— Fabienne Bourgeois, MD, MPH, pediatric hospitalist and the Medical Director of Patient-Facing Applications at Boston Children’s Hospital.
What should I do if I can’t see any of my notes or a specific note I expected to see?
- The clinician may not yet be sharing notes. We encourage you to talk with the clinician and let him or her know that you would like to read your child’s notes.
- The note may not be ready. After the clinician writes and approves the note electronically, the note will become available.
- Your clinician may have chosen not to share this particular note or type of note. If you have questions, we encourage you to talk with your child’s clinician or the clinician’s practice to make sure you understand his or her reasons for not making the note available.
What if I have a question about something in the note?
Please keep in mind that the note is part of your medical record. Doctors and/or other clinicians use the note to manage your individual circumstances and to communicate efficiently with others involved in your care. You may find the note difficult to read because it includes unfamiliar abbreviations or terms. It’s okay to use trusted online resources to look information up or to contact your health care team if there’s something you don’t understand, if you are unable to follow the care plan, or are concerned about a diagnostic test, study results, or other aspects of your care.
What if I find an error or inaccuracy?
If you see an error or inaccuracy that could affect your child’s care, your care team will want to know. Never hesitate to call or send a secure message.
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This post is part of our series on the best books and resources to help you perform well on your third year rotations and shelf exams. Also check out our lists for clerkships in Internal Medicine, Family Medicine, OB/GYN, General Surgery, Neurology, Psychiatry, Pediatrics, and Emergency Medicine. You can also check out our complete list of 'Best Books' lists for medical students here.
Background: Clerkship Grades
At the beginning of each of these clerkship lists there are a few things I must say. First, your grade on clinical rotations will depend on both your clinical performance and your performance on a shelf exam at the end of the rotation. While it is true that how you work with your teams and patients will play into your evaluation, there is no denying that your knowledge of the subject matter is, by far, the most important part of your final grade because it directly affects both of these two areas of evaluation. As a resident, I currently find myself filling out medical student evaluations every week. There are very few 'incredible' medical students and very few 'terrible' medical students. The vast majority of you (~95%) fit into the 'good and easy to work with' group; the only thing you have to set you apart from others is your knowledge base. You have no alternative but to study! First Aid for the Wards is a great resource to understand the dynamics of your clinical rotations, I highly recommend it.
Essential Resources
The resources I will describe in the clerkship lists are books and online question banks. From the onset let me point out two indespesible resources that I will not list for each rotation individually.
- First, I consider a great online question bank essential. Both Kaplan and USMLE World are very good products. I highly recommend purchasing a one year subscription to one of these USMLE Step 2 question banks. As you complete your third year rotations, these question banks will prepare you for 1- your clinical duties, 2- your rotation shelf exam, and 3- the USMLE Step 2 during your fourth year.
- Second, online review materials (e.g. Medscape, UpToDate, etc.) are essential resources to prepare for your patients in the hospital. The books and question banks can never provide the type of in-depth detail about disease processes that you will need to learn how to properly take care of your specific patients. To be a great medical student, you must prepare more profoundly for the diseases you are encountering personally in the hospital.
Book Series for Third Year
Medical students are not all made the same; we are all very different learners. There are a number of companies producing review materials for third year medical students, each with a slightly different focus. Each of these companies produce a different book for each clerkship. Interestingly, some companies' books are rated higher in some clerkships than others. If you find a product that works for you, consider sticking with it during your third year even if that product is not 'rated' as highly for a specific clerkship. Below are a few of the review products and their features.
- The Case Files Series: A unique teaching model; the Case Files series introduces a number of important clinical cases and follows them up with clinical pearls and important concepts. For students who need vivid clinical situations to remember factoids and concepts, this is a great series. (Case Files Pediatrics)
- The PreTest Series: The PreTest series is a classic question bank format with questions and detailed explanations. As I previously mentioned, I believe there is no substitute for a great question bank. While an online resource (USMLE World or Kaplan) can be more robust and mobile, a good question book is still a great option. The PreTest series produces a couple fantastic question banks. (PreTest Pediatrics).
- The BluePrints Series: The BluePrints series has a beautiful format that is very easy to read. The text is laid out in a bulleted lists, but with more details and descriptions than the First Aid series with which most students are familiar. I think very highly of these review books. (Blueprints Pediatrics).
- First Aid Clerkship Series: The First Aid series well known to most students also produces review books for third year clerkships. The content is similar to what students are used to, bulleted lists of high yield information. While I highly recommend many of the First Aid review books for USMLE Step preparation, the books are not quiteas widely read and recommended for clerkships. (First Aid for the Pediatrics Clerkship).
Best Books for Pediatrics Rotation
So, we can agree that books are not sufficient for success on your clerkships, but they are still an incredible resource that you should tap into. Let's review the best books and resources for your Pediatrics rotation. These lists come from both my experience and also from one medical school's annual survey of its 250 graduating medical students who try to detail which resources were the most useful on their rotations.
Studying for the pediatrics rotation is not nearly as daunting as other rotations because the material is better partitioned than the more broad rotations. You will have to know both inpatient and outpatient peds very well, but do not spend all your time memorizing milestones, vaccine schedules, and inpatient conversions. There are quite a large number of highly rated books for this rotation, so choose one that fits your learning style.
1. PreTest Pediatrics: Probably the best in the PreTest series, the PreTest Pediatrics book is well rated by every metric. I remember 3-4 questions on my shelf that were near duplicates of PreTest questions; this is high yeild material. It is not, however, sufficient for your shelf. You must find a more complete text to study from as well. | |
2. Blueprints Pediatrics: This is a very complete text and highlights well both the inpatient and outpatient concepts in pediatric medicine. If you have time to get through and remember the information in this text it will lead to a good score on the shelf. | |
3. Case Files Pediatrics:A well written book that is highly regarded by students. There is nothing special about this particular volume of the Case Files Series, but if you like the series this is a good bet. | |
4. BRS Pediatrics:This is an interesting addition to our Best Books list. Students in my medical school and on annual book surveys rave about this book. It is a bit outdated (last edition printed in 2004) so I did not read it, but even though it is older, students still swear by it. |