Patient access to electronic psychiatric records: A pilot study

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

“…By signaling trust in the patient as a "grownup" care partner, and by facilitating greater time to reflect on disclosures, open notes may strengthen patients' sense of agency and can conceivably play a role in improving outcomes (35). Patients express considerable interest in accessing their clinical records, including their mental health notes, and surveys suggest that only small numbers of patients are confused by what they have read (7,12,36,37). These findings are supported by qualitative research where many patients describe the enhanced levels of trust and confidence in clinicians, greater understanding about their health and treatment plans, and feelings of personal validation on reading their notes (7,(38)(39)(40).…”

“…As noted, a major perceived difficulty with informed consent to psychotherapy is adequately communicating procedural aspects of care; yet, as a result of accessing their psychotherapy notes some patients report a better understanding of what goes on in sessions and greater insight into their personal goals and their progress (7,34,36); for example: "[H]elps affirm what I'm working on" (7). Supporting these findings, in a recent study involving patients' access to psychotherapy notes (n = 85), more than half of those surveyed reported that reading their notes was "very important" or "extremely important" for feeling in control of their care (7).…”

“…Benefits in helping patients with homework and other skills rehearsal are also clear. Recent findings also suggest that access to the clinical notes can deepen patient engagement (36); for example: "Better informed and aware of when something needs clarification" (7).…”

Easy Access, Difficult Consequences? Providing Psychiatric Patients With Access to Their Health Records Electronically

“…Following this publication, several psychiatrists opened up their clinical notes to patients electronically through patient portals and have been providing access ever since (3). Despite initial concerns from providers about what opening up their notes might to do therapy and care, these concerns have generally not been realized (4,5). We believe that more effort needs to be made to support providers in feeling more comfortable opening up their notes.…”

“…Since there have now been implementations of psychiatric patient portals with OpenNotes in numerous organizations, the question is now: what have the experiences been of providers? Generally speaking the literature has shown that the concerns of providers who are less comfortable with the idea of opening up their notes, have not been realized (4,5). Although providers are concerned about a number of topics pre-implementation, the post-implementation reality seems incongruent with these initial concerns.…”