Does Patient Access to Clinical Notes Change Documentation?

Blease, Charlotte; Torous, John; Hägglund, Maria

doi:10.3389/fpubh.2020.577896

Cited by 40 publications

(34 citation statements)

References 27 publications

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“…Congruent with our findings, previous research has reported on how patient access to EHRs can result in changes to clinicians’ documentation practices. In particular, our findings support previous research by Blease and colleagues’ and the notion of medical records being used as form of ‘cognitive scaffolding’ to support memory and diagnostic reasoning, and how changes to documentation approaches to minimise or prevent anxiety for patients may undermine a key purpose of record keeping [ 25 ]. By taking a qualitative approach, our findings map onto and provide further detail to many of the benefits and challenges proposed by previous research, reinforcing the significance of these issues from a UK perspective.…”

Section: Discussionsupporting

confidence: 86%

“…This echoed concerns highlighted in previous research also from the health care professional perspective [ 24 ]. Indeed, research by Blease and colleagues’ which considered whether patient access to clinical notes changes documentation, suggested that although patients’ and clinicians’ experiences of the practice are generally positive, there are some potential risks [ 25 ]. For example, clinicians have reported changes to documentation practices such as less detailed notes, and removal of language that could be perceived as critical.…”

Section: Introductionmentioning

confidence: 99%

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What do primary care staff think about patients accessing electronic health records? A focus group study

Louch

Albutt

Smyth

et al. 2022

BMC Health Serv Res

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Background Patients have expressed a growing interest in having easy access to their personal health information, and internationally there has been increasing policy focus on patient and care records being more accessible. Limited research from the UK has qualitatively explored this topic from the primary care staff perspective. This study aimed to understand what primary care staff think about patients accessing electronic health records, highlighting errors in electronic health records, and providing feedback via online patient portals. Methods A focus group study involving 19 clinical and non-clinical primary care staff. Primary care practices were purposively sampled based on practice size and the percentage of patients using online services. Data were analysed inductively using reflexive thematic analysis. Results Three themes were generated: (1) Information – what, why and when? (2) Changing behaviours and protecting relationships, and (3) Secure access and safeguarding. The emotional considerations and consequences for staff and patients featured prominently in the data as an overarching theme. Conclusions Primary care staff described being invested and supportive of patients accessing their electronic health records, and acknowledged the numerous potential benefits for safety. Uncertainty around the parameters of access, the information available and what this might look like in the future, processes for patients highlighting errors in records, relational issues, security and safeguarding and equitable access, were key areas warranting examination in future research.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

What do primary care staff think about patients accessing electronic health records? A focus group study

Louch

Albutt

Smyth

et al. 2022

BMC Health Serv Res

View full text Add to dashboard Cite

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“…Fifth, further research should explore how PAEHRs affect documentation [80]. For example, it is not known whether access changes the quality of mental notes.…”

Section: Future Researchmentioning

confidence: 99%

Sharing Clinical Notes and Electronic Health Records With People Affected by Mental Health Conditions: Scoping Review

Schwarz¹,

Bärkås²,

Blease³

et al. 2021

JMIR Ment Health

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Background Electronic health records (EHRs) are increasingly implemented internationally, whereas digital sharing of EHRs with service users (SUs) is a relatively new practice. Studies of patient-accessible EHRs (PAEHRs)—often referred to as open notes—have revealed promising results within general medicine settings. However, studies carried out in mental health care (MHC) settings highlight several ethical and practical challenges that require further exploration. Objective This scoping review aims to map available evidence on PAEHRs in MHC. We seek to relate findings with research from other health contexts, to compare different stakeholders’ perspectives, expectations, actual experiences with PAEHRs, and identify potential research gaps. Methods A systematic scoping review was performed using 6 electronic databases. Studies that focused on the digital sharing of clinical notes or EHRs with people affected by mental health conditions up to September 2021 were included. The Mixed Methods Appraisal Tool was used to assess the quality of the studies. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Extension for Scoping Reviews guided narrative synthesis and reporting of findings. Results Of the 1034 papers screened, 31 were included in this review. The studies used mostly qualitative methods or surveys and were predominantly published after 2018 in the United States. PAEHRs were examined in outpatient (n=29) and inpatient settings (n=11), and a third of all research was conducted in Veterans Affairs Mental Health. Narrative synthesis allowed the integration of findings according to the different stakeholders. First, SUs reported mainly positive experiences with PAEHRs, such as increased trust in their clinician, health literacy, and empowerment. Negative experiences were related to inaccurate notes, disrespectful language use, or uncovering of undiscussed diagnoses. Second, for health care professionals, concerns outweigh the benefits of sharing EHRs, including an increased clinical burden owing to more documentation efforts and possible harm triggered by reading the notes. Third, care partners gained a better understanding of their family members’ mental problems and were able to better support them when they had access to their EHR. Finally, policy stakeholders and experts addressed ethical challenges and recommended the development of guidelines and trainings to better prepare both clinicians and SUs on how to write and read notes. Conclusions PAEHRs in MHC may strengthen user involvement, patients’ autonomy, and shift medical treatment to a coproduced process. Acceptance issues among health care professionals align with the findings from general health settings. However, the corpus of evidence on digital sharing of EHRs with people affected by mental health conditions is limited. Above all, further research is needed to examine the clinical effectiveness, efficiency, and implementation of this sociotechnical intervention.

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“…Regardless, there appears to be room for improvement in this area, and both patient and health care professional education may be needed. How patient access may affect the way health care professionals actually document information is also an underexplored area [41], especially in domains such as mental health, where health care professionals have reported leaving important information out of the record as patients gain access to it [42,43].…”

Section: Paehrs As a Tool For Patient Safetymentioning

confidence: 99%

Usability of the Swedish Accessible Electronic Health Record: Qualitative Survey Study

Hägglund¹,

Scandurra²

2022

JMIR Hum Factors

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Background Patient portals are increasingly being implemented worldwide to ensure that patients have timely access to their health data, including patients’ access to their electronic health records. In Sweden, the e-service Journalen is a national patient-accessible electronic health record (PAEHR), accessible on the web through the national patient portal. User characteristics and perceived benefits of using a PAEHR will influence behavioral intentions to use and adoption; however, poor usability, which increases effort expectancy, may have a negative impact. Therefore, it is of interest to further explore how users of the PAEHR Journalen perceive its usability and usefulness. Objective On the basis of the analysis of the survey respondents’ experiences of the usability of the Swedish PAEHR, this study aimed to identify specific usability problems that may need to be addressed in the future. Methods A survey study was conducted to elicit opinions and experiences of patients using Journalen. Data were collected from June to October 2016. The questionnaire included a free-text question regarding the usability of the system, and the responses were analyzed using content analysis with a sociotechnical framework as guidance when grouping identified usability issues. Results During the survey period, 423,141 users logged into Journalen, of whom 2587 (0.61%) completed the survey (unique users who logged in; response rate 0.61%). Of the 2587 respondents, 186 (7.19%) provided free-text comments on the usability questions. The analysis resulted in 19 categories, which could be grouped under 7 of the 8 dimensions in the sociotechnical framework of Sittig and Singh. The most frequently mentioned problems were related to regional access limitations, structure and navigation of the patient portal, and language and understanding. Conclusions Although the survey respondents, who were also end users of the PAEHR Journalen, were overall satisfied with its usability, they also experienced important challenges when accessing their records. For all patients to be able to reap the benefits of record access, it is essential to understand both the usability challenges they encounter and, more broadly, how policies, regulations, and technical implementation decisions affect the usefulness of record access. The results presented here are specific to the Swedish PAEHR Journalen but also provide important insights into how design and implementation of record access can be improved in any context.

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Does Patient Access to Clinical Notes Change Documentation?

Cited by 40 publications

References 27 publications

What do primary care staff think about patients accessing electronic health records? A focus group study

What do primary care staff think about patients accessing electronic health records? A focus group study

Sharing Clinical Notes and Electronic Health Records With People Affected by Mental Health Conditions: Scoping Review

Usability of the Swedish Accessible Electronic Health Record: Qualitative Survey Study

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