Preparing Patients and Clinicians for Open Notes in Mental Health: Qualitative Inquiry of International Experts

Abstract

Background In a growing number of countries worldwide, clinicians are sharing mental health notes, including psychiatry and psychotherapy notes, with patients. Objective The aim of this study is to solicit the views of experts on provider policies and patient and clinician training or guidance in relation to open notes in mental health care. Methods In August 2020, we conducted a web-based survey of international experts on the practice of sharing mental health notes. Experts were identified as informaticians, clinicians, chief medical information officers, patients, and patient advocates who have extensive research knowledge about or experience of providing access to or having access to mental health notes. This study undertook a qualitative descriptive analysis of experts’ written responses and opinions (comments) to open-ended questions on training clinicians, patient guidance, and suggested policy regulations. Results A total of 70 of 92 (76%) experts from 6 countries responded. We identified four major themes related to opening mental health notes to patients: the need for clarity about provider policies on exemptions, providing patients with basic information about open notes, clinician training in writing mental health notes, and managing patient-clinician disagreement about mental health notes. Conclusions This study provides timely information on policy and training recommendations derived from a wide range of international experts on how to prepare clinicians and patients for open notes in mental health. The results of this study point to the need for further refinement of exemption policies in relation to sharing mental health notes, guidance for patients, and curricular changes for students and clinicians as well as improvements aimed at enhancing patient and clinician-friendly portal design.

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

“…The research team developed a standardized template to extract and chart relevant data from the included studies [5,[12][13][14][15][16][17][18][19][20][21][22][23][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56]. The following parameters were recorded in detail: reference ID, authors, year, country, design, sample, participants, treatment setting and medical specialty, study purpose, and a summary of the results.…”

“…The following parameters were recorded in detail: reference ID, authors, year, country, design, sample, participants, treatment setting and medical specialty, study purpose, and a summary of the results. The data were extracted by JS and AB, and checked for accuracy and completeness by CB (see Multimedia Appendix 2 [5,[12][13][14][15][16][17][18][19][20][21][22][23][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56] for more information).…”

“…Instead, a detailed description of the quality of the included studies is provided based on the MMAT grading results. A comprehensive presentation of the individual ratings of each criterion can be found in Multimedia Appendix 3 [5,[12][13][14][15][16][17][18][19][20][21][22][23][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56].…”

“…In such cases, the rules specify that risks must reach a clinical threshold well beyond the patient being upset [10]. However, as noted, these rules leave considerable latitude for interpretation, and so far, there are no clear procedures for monitoring or auditing clinicians' decisions [12]. Moreover, beyond legal rulings, many HCPs report concern that SUs will become anxious or confused if they are offered access to their PAEHR [3,13].…”

The benefits and harms of open notes in mental health: A Delphi survey of international experts

“…Combined, empirical research should aim to inform how the innovation might be optimized for its new dual purpose–both as a detailed aide memoire for clinicians and as a tool for communication with patients. Finally, it remained unresolved when redaction of aspects of mental records from patients might be appropriate [ 29 ], and future research should elaborate on how best this can be practically and ethically managed for both patients and clinicians [ 30 ].…”