Impacts of a Web-Based Course on Mental Health Clinicians’ Attitudes and Communication Behaviors Related to Use of OpenNotes

Abstract

The OpenNotes initiative encourages health care systems to provide patients online access to clinical notes. Some individuals have expressed concerns about use of OpenNotes in mental health care. This study evaluated changes in mental health clinicians' attitudes and communications with patients after participation in a Web-based course designed to reduce potential for unintended consequences and enhance likelihood of positive outcomes of OpenNotes.Methods: All 251 mental health clinicians (physicians, nurse practitioners, psychologists, and social workers) of a large U.S. Department of Veterans Affairs facility were invited to participate. Clinicians completed surveys at baseline and 3 months after course participation. Ten items were examined that addressed clinicians' concerns and communication behaviors with patients. Mixed-effects models with repeated measures were used to compare pre-post data.Results: Of the 251 clinicians, 141 (56%) completed baseline surveys, and 113 (80%) completed baseline and postcourse surveys. Of the 141 clinicians, 63% were female, 46% were social workers, 34% were psychologists, 16% were psychiatrists, and 4% were nurse practitioners. In final adjusted models, pre-post item scores indicated significant increases in clinicians' ability to communicate with and educate patients (p,.01) and in the frequency with which clinicians educated patients about OpenNotes access (p,.001), advised patients to access and read notes (p,.01), and asked patients about questions or concerns they have with notes (p=.04). There was also a significant reduction in clinicians' worry about negative consequences (p=.05). Conclusions:A Web-based course for mental health clinicians on use of OpenNotes resulted in self-reported improvements in some concerns and in aspects of patientclinician communication.

Does Patient Access to Clinical Notes Change Documentation?

“…Going further, we suggest that in the new era of open notes, it is imperative that all clinicians are trained in how to preserve the traditional functions of medical notes, and in maximizing the potential new benefits of this communication tool. Preliminary evidence from web-based clinician training programs suggests that this is achievable (29). Tracking changes in clinical documentation will be key to assess the impact of clinician training, and to evaluate how modifications to clinical notes influence patients' experiences and clinical outcomes.…”

Empowering patients and reducing inequities: is there potential in sharing clinical notes?

“…By expanding opportunities for online communication, open notes might provide more instances for providers and patients to communicate in a context in which discrimination is less likely to arise. Web-based courses may help clinicians to write notes that are both more sensitive to patients’ needs and also document patients’ strengths 24. Open notes might prompt clinicians to include less stigmatising language.…”

Sharing Clinical Notes in Psychotherapy: A New Tool to Strengthen Patient Autonomy

“…For example, some survey respondents report being offended or feeling judged by what they read, or detect inconsistencies between the notes and what transpired in therapy sessions (7,34). Therefore, to cultivate relational autonomy, clinicians will require training on how to write clear, accurate, respectful, and supportive notes (8,(41)(42)(43).…”