A Qualitative Analysis of How Online Access to Mental Health Notes Is Changing Clinician Perceptions of Power and the Therapeutic Relationship

Denneson, Lauren M.; Cromer, Risa; Williams, Holly B.; Pisciotta, Maura; Dobscha, Steven K.

doi:10.2196/jmir.6915

Cited by 71 publications

(88 citation statements)

References 18 publications

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“…Findings from studies in the United States indicate the same concerns, with concerns that the increased transparency would “water down” the content in the records [ 11 ]. Mental health clinicians in the United States also claimed that they were more careful about what they wrote to protect themselves and their patients [ 12 ]. The results from the postimplementation survey indicate that there have been changes in clinical documentation: over 60% of the psychologists and nearly 40% of the doctors stated that they were less candid in their documentation after the implementation of Open Notes.…”

Section: Discussionmentioning

confidence: 99%

Open Notes in Swedish Psychiatric Care (Part 2): Survey Among Psychiatric Care Professionals

Petersson¹,

Erlingsdóttir²

2018

JMIR Ment Health

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BackgroundThis is the second of two papers presenting the results from a study of the implementation of patient online access to their electronic health records (here referred to as Open Notes) in adult psychiatric care in Sweden. The study contributes an important understanding of both the expectations and concerns that existed among health care professionals before the introduction of the Open Notes Service in psychiatry and the perceived impact of the technology on their own work and patient behavior after the implementation. The results from the previously published baseline survey showed that psychiatric health care professionals generally thought that Open Notes would influence both the patients and their own practice negatively.ObjectiveThe objective of this study was to describe and discuss how health care professionals in adult psychiatric care in Region Skåne in southern Sweden experienced the influence of Open Notes on their patients and their own practice, and to compare the results with those of the baseline study.MethodsWe distributed a full population Web-based questionnaire to psychiatric care professionals in Region Skåne in the spring of 2017, which was one and a half years after the implementation of the service. The response rate was 27.73% (699/2521). Analyses showed that the respondents were representative of the staff as a whole. A statistical analysis examined the relationships between health professional groups and attitudes to the Open Notes Service.ResultsA total of 41.5% (285/687) of the health care professionals reported that none of their patients stated that they had read their Open Notes. Few health care professionals agreed with the statements about the potential benefits for patients from Open Notes. Slightly more of the health care professionals agreed with the statements about the potential risks. In addition, the results indicate that there was little impact on practice in terms of longer appointments or health care professionals having to address patients’ questions outside of appointments. However, the results also indicate that changes had taken place in clinical documentation. Psychologists (39/63, 62%) and doctors (36/94, 38%) in particular stated that they were less candid in their documentation after the implementation of Open Notes. Nearly 40% of the health care professionals (239/650, 36.8%) reported that the Open Notes Service in psychiatry was a good idea.ConclusionsMost health care professionals who responded to the postimplementation survey did not experience that patients in adult psychiatric care had become more involved in their care after the implementation of Open Notes. The results also indicate that the clinical documentation had changed after the implementation of Open Notes. Finally, the results indicate that it is important to prepare health care professionals before an implementation of Open Notes, especially in medical areas where the service is considered sensitive.

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Section: Discussionmentioning

confidence: 99%

Open Notes in Swedish Psychiatric Care (Part 2): Survey Among Psychiatric Care Professionals

Petersson¹,

Erlingsdóttir²

2018

JMIR Ment Health

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“…The OpenNotes Project in the United States has also expressed concerns that increased transparency may water down the content of the records [ 2 ]. Furthermore, in a recent study of Open Notes at the VA System in the United States, mental health clinicians claim that they are more careful about what they write to protect the patients and themselves [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Open Notes in Swedish Psychiatric Care (Part 1): Survey Among Psychiatric Care Professionals

Petersson¹,

Erlingsdóttir²

2018

JMIR Ment Health

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BackgroundWhen the Swedish version of Open Notes, an electronic health record (EHR) service that allows patients online access, was introduced in hospitals, primary care, and specialized care in 2012, psychiatric care was exempt. This was because psychiatric notes were considered too sensitive for patient access. However, as the first region in Sweden, Region Skåne added adult psychiatry to its Open Notes service in 2015. This made it possible to carry out a unique baseline study to investigate how different health care professionals (HCPs) in adult psychiatric care in the region expect Open Notes to impact their patients and their practice. This is the first of two papers about the implementation of Open Notes in adult psychiatric care in Region Skåne.ObjectiveThe objective of this study was to describe, compare, and discuss how different HCPs in adult psychiatric care in Region Skåne expect Open Notes to impact their patients and their own practice.MethodsA full population Web-based questionnaire was distributed to psychiatric care professionals in Region Skåne in late 2015. The response rate was 28.86% (871/3017). Analyses show that the respondents were representative of the staff as a whole. A statistical analysis examined the relationships between different professionals and attitudes to the Open Notes service.ResultsThe results show that the psychiatric HCPs are generally of the opinion that the service would affect their own practice and their patients negatively. The most striking result was that more than 60% of both doctors (80/132, 60.6%) and psychologists (55/90, 61%) were concerned that they would be less candid in their documentation in the future.ConclusionsOpen Notes can increase the transparency between patients and psychiatric HCPs because patients are able to access their EHRs online without delay and thus, can read notes that have not yet been approved by the responsible HCP. This may be one explanation as to why HCPs are concerned that the service will affect both their own work and their patients.

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“…Specifically, they articulated ambivalence around the desire to document in a clinically accurate way while protecting patients from potential harm, and concern about the medicolegal risk in adjusting their practice accordingly. 56,57 Patients' Perspectives on OpenNotes…”

Section: Clinicians' Perspectives On Opennotesmentioning

confidence: 99%

Patients as Agents in Behavioral Health Research and Service Provision: Recommendations to Support the Learning Health System

Galvin¹,

Petersen

Subbian

et al. 2019

Appl Clin Inform

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Authentic inclusion and engagement of behavioral health patients in their care delivery and in the process of scientific discovery are often challenged in the health care system. Consequently, there is a growing need to engage with and better serve the needs of behavioral health patients, particularly by leveraging health information technologies. In this work, we present rationale and strategies for improving patient engagement in this population in research and clinical care. First, we describe the potential for creating meaningful patient–investigator partnerships in behavioral health research to allow for cocreation of knowledge with patients. Second, in the context of behavioral health services, we explore the utility of sharing clinical notes to promote patients' agency in care delivery. Both lines of inquiry are centered in a Learning Health System model for behavioral health, where patients are agents in enhancing the therapeutic alliance and advancing the process of knowledge generation. Recommendations include genuinely democratizing the health care system and biomedical research enterprise through patient-centered information technologies such as patient portals. In research and technology development, we recommend seeking and tailoring behavioral health patients' involvement to their abilities, promoting patient input in data analysis plans, evaluating research and informatics initiatives for patients and clinicians, and sharing success and research findings with patients. In clinical practice, we recommend encouraging patients to read behavioral health notes on portals, engaging in proactive communication regarding note content, assessing outcomes including stress and anxiety in response to note content, and working with technology providers to support note-sharing governance and deployment.

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A Qualitative Analysis of How Online Access to Mental Health Notes Is Changing Clinician Perceptions of Power and the Therapeutic Relationship

Cited by 71 publications

References 18 publications

Open Notes in Swedish Psychiatric Care (Part 2): Survey Among Psychiatric Care Professionals

Open Notes in Swedish Psychiatric Care (Part 2): Survey Among Psychiatric Care Professionals

Open Notes in Swedish Psychiatric Care (Part 1): Survey Among Psychiatric Care Professionals

Patients as Agents in Behavioral Health Research and Service Provision: Recommendations to Support the Learning Health System

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