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

Blease, Charlotte; Walker, Jan; Torous, John; O’Neill, Stephen

doi:10.3389/fpsyt.2020.527872

Cited by 18 publications

(14 citation statements)

References 44 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In light of the new ruling in the United States and advances in patient access in the Nordic countries, evaluating the effects of PAEHR in mental health care (MHC) is particularly timely. As previous publications have stressed, PAEHR in MHC raises new practice dilemmas [10,31] but might also offer new opportunities to empower patients [32]. In the era of transparency, HCPs must now balance respect for patient autonomy and open and transparent information disclosures with duties to prevent patient harm.…”

Section: Context and Scope For The Reviewmentioning

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

View full text Add to dashboard Cite

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.

show abstract

Section: Context and Scope For The Reviewmentioning

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

View full text Add to dashboard Cite

show abstract

“…According to Fricker, the sharing and production of knowledge is a valued good; as such, inequalities in access to such knowledge and to participation in knowledge formation activities constitute an ethical wrong that can lead to primary and secondary harms [33]. In the case of shared notes, it is argued that patients who are precluded from reading their notes are thereby denied opportunities to feel more in control of their care [4,12], to better understand their mental health [15], and to facilitate patient autonomy [11,16] and empowerment [11]. Failure to access notes also means that patients cannot correct errors, omissions, or inaccuracies in their records.…”

Section: Discussionmentioning

confidence: 99%

“…However, many organizations that implement PAEHRs do not share mental health notes written by psychiatry professionals or give limited access to notes from psychiatry clinics. Research shows that the sharing of mental health notes enhances patient empowerment [2,10,11], increases the sense of control in their care [4,[12][13][14][15][16] and augments patient autonomy [11,16].…”

Section: Introductionmentioning

confidence: 99%

Patients’ Access to Their Psychiatric Notes: Current Policies and Practices in Sweden

Bärkås

Scandurra

Rexhepi

et al. 2021

IJERPH

View full text Add to dashboard Cite

Patients’ access to electronic health records (EHRs) is debated worldwide, and access to psychiatry records is even more criticized. There is a nationwide service in Sweden which offers all citizens the opportunity to read their EHR, including clinical notes. This study aims to explore Swedish national and local policy regulations regarding patients’ access to their psychiatric notes and describe to what extent patients currently are offered access to them. The rationale behind the study is that current policies and current practices may differ between the 21 self-governing regions, although there is a national regulation. We gathered web-based information from policy documents and regulations from each region’s website. We also conducted key stakeholder interviews with respondents from the regions and cross-regional private care providers, using a qualitative approach. The results show that 17 of 21 regions share psychiatric notes with patients, where forensic psychiatric care was the most excluded psychiatric care setting. All private care providers reported that they mainly follow the regions’ guidelines. Our findings show that regional differences concerning sharing psychiatric notes persist, despite Swedish regulations and a national policy that stipulates equal care for everyone. The differences, however, appear to have decreased over time, and we report evidence that the regions are moving toward increased transparency for psychiatry patients.

show abstract

“…While clinicians may express concern about disruptions to the therapeutic alliance, many patients articulate significant increases in satisfaction associated with the "Open Note Rule" [7,8]. In fact, Open Notes can be associated with improved medication adherence in patients with serious mental illness and even improved trust between patients and providers [9]. The Open Notes Rule may help clinicians recognize that medical documentation belongs to the patient, as opposed to the clinician, which could bridge communication gaps, and allow for the development of new, clear and effective communication strategies between clinicians and their patients.…”

Section: Discussionmentioning

confidence: 99%

Open Notes and Closed-Loop Communication: A Case of Factitious Disorder in the Age of Transparent Medical Records

Elana¹,

Bryan²,

Robbins-Welty³

et al. 2021

J Psychiatry Treat Res

View full text Add to dashboard Cite

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

Cited by 18 publications

References 44 publications

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

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

Patients’ Access to Their Psychiatric Notes: Current Policies and Practices in Sweden

Open Notes and Closed-Loop Communication: A Case of Factitious Disorder in the Age of Transparent Medical Records

Contact Info

Product

Resources

About