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Moll J, Myreteg G, Rexhepi H. Experiences of Patients With Mental Health Issues Having Web-Based Access to Their Records: National Patient Survey. JMIR Ment Health 2024; 11:e48008. [PMID: 38306158 PMCID: PMC10873793 DOI: 10.2196/48008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 10/20/2023] [Accepted: 10/29/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Sharing mental health notes through patient accessible electronic health records (PAEHRs) is controversial. Many psychiatric organizations and regions in Sweden have resisted the implementation, as clinicians worry about possible harms when patients are reading their notes. Despite the documented benefits of PAEHRs, there is still a lack of knowledge regarding whether patients with mental health issues could reap similar benefits of reading their notes as other patient groups. OBJECTIVE The aim of the study is to examine the use, attitudes, and experiences of patients with mental health issues by reading their notes in the PAEHR and, moreover, whether their experiences differ from other patient groups, and if so, how. METHODS A national patient survey was conducted with answers from 2587 patients from different patient groups. In total, 504 respondents (19.5%) indicated that they experienced a mental health disease. Answers from this patient group were compared to the answers from all other respondents. Survey questions related to attitudes, information usage, and effects on contacts with care were selected for analysis. Mann-Whitney U tests were used to detect groupwise differences. RESULTS Patients with mental health issues use PAEHRs for checking that they have received the right care (mean_mental health 2.83, SD_mental health 1.39; mean_others 2.62, SD_others 1.37; P=.002) or suspected inaccuracies (mean_mental health 2.55, SD_mental health 1.34; mean_others 2.31, SD_others 1.30; P=.001), blocking access for professionals in other specialties (mean_mental health 3.43, SD_mental health 1.46; mean_others 3.04, SD_others 1.42; P<.001), and checking which care professionals have accessed their record (mean_mental health 4.28, SD_mental health 1.14; mean_others 4.05, SD_others 1.25; P<.001) to a significantly higher degree than other patients. On the other hand, the results show that a significantly lower proportion of patients with mental health issues (mean_mental health 3.38, SD_mental health 1.21; mean_others 3.52, SD_others 1.18; P=.02) believe that PAEHRs help them in shared decision-making compared to other patient groups. CONCLUSIONS Patients with mental health issues who took part in the survey, as a group, express some minor differences in both the use of the PAEHR and their experiences regarding its usefulness, as compared to other patients, as a group. This patient group shows a slightly higher interest in 2 types of use: checking for accuracy of care in the record and blocking access to mental health notes for professionals from other parts of the health care system. Compared to other patient groups, these patients are less likely to experience that the PAEHR is a support in shared decision-making. The study indicates that the benefits of PAEHR on a general level are the same for this patient group as for other patients. The study does not support clinicians' worry about possible harm to this patient group. Further research is however needed.
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Affiliation(s)
- Jonas Moll
- Centre for Empirical Research on Information Systems, Örebro University School of Business, Örebro University, Örebro, Sweden
| | - Gunilla Myreteg
- Department of Business Studies, Uppsala University, Uppsala, Sweden
| | - Hanife Rexhepi
- School of Informatics, University of Skövde, Skövde, Sweden
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2
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Ling S, Kassam I, Haider S, Lo B, Strudwick G. Pre-implementation perceptions of clinicians regarding a patient portal in inpatient addictions settings: A qualitative descriptive study. Int J Med Inform 2023; 180:105278. [PMID: 37922661 DOI: 10.1016/j.ijmedinf.2023.105278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 10/06/2023] [Accepted: 10/28/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Patient portals have been implemented in many organizations to support patient engagement and empowerment. However, their use in inpatient mental health and addiction settings is relatively new and has not been extensively studied. To address this gap, this study explored clinician perspectives of implementing a patient portal in inpatient addiction settings. METHODS The study followed qualitative descriptive methodology and used the Consolidated Framework for Implementation Research (CFIR) to guide the research. Interviews were conducted with clinicians working in an inpatient addictions service at a large mental health and addictions teaching hospital in Toronto, Canada. Data analysis was performed using directed content analysis and the CFIR domains. RESULTS Twelve clinicians participated in semi-structured interviews. Participants included prescribers (such as physicians and nurse practitioners), registered nurses, allied health clinicians, and leadership. Participants had positive attitudes toward the patient portal, believing it would benefit patients and support consistency in healthcare. However, they also expressed reservations about its relevance and value during short inpatient admissions. Clinicians perceived the patient portal as compatible with existing workflows, enhancing patient empowerment and facilitating access to medical documentation. Concerns were raised about potential negative impacts on therapeutic rapport, particularly if patients disagreed with or were upset by the contents of their notes. Adaptations to the portal, such as improving documentation templates and providing detailed medication information, were suggested. Participants also highlighted advantages of the portal, including secure communication and access to laboratory results. CONCLUSIONS Clinicians generally had positive attitudes toward implementing a patient portal. However, concerns about maintaining therapeutic rapport and the relevance of information to patients were identified, and adaptations were suggested to improve the utility of a portal in the context of short inpatient stays. The findings provide insights into clinician perspectives and can inform the implementation of patient portals in inpatient addiction settings.
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Affiliation(s)
- Sara Ling
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
| | - Iman Kassam
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Shaista Haider
- Acute Care Progam, Centre for Addiction and Mental Health, Toronto, Canada
| | - Brian Lo
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Gillian Strudwick
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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3
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Lam BD, Dupee D, Gerard M, Bell SK. A Patient-Centered Approach to Writing Ambulatory Visit Notes in the Cures Act Era. Appl Clin Inform 2023; 14:199-204. [PMID: 36889340 PMCID: PMC9995217 DOI: 10.1055/s-0043-1761436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Affiliation(s)
- Barbara D. Lam
- Division of Hematology and Oncology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
| | - David Dupee
- Department of Psychiatry and Behavioral Sciences, Stanford Medicine, Stanford, California, United States
| | - Macda Gerard
- Department of Obstetrics and Gynecology, Boston Medical Center, Boston, Massachusetts, United States
| | - Sigall K. Bell
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
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4
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Blease C, McMillan B, Salmi L, Davidge G, Delbanco T. Adapting to transparent medical records: international experience with "open notes". BMJ 2022; 379:e069861. [PMID: 36410770 DOI: 10.1136/bmj-2021-069861] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Charlotte Blease
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian McMillan
- Centre for Primary Care and Health Services Research, University of Manchester, UK
| | - Liz Salmi
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Gail Davidge
- Centre for Primary Care and Health Services Research, University of Manchester, UK
| | - Tom Delbanco
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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5
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Zanaboni P, Kristiansen E, Lintvedt O, Wynn R, Johansen MA, Sørensen T, Fagerlund AJ. Impact on patient-provider relationship and documentation practices when mental health patients access their electronic health records online: a qualitative study among health professionals in an outpatient setting. BMC Psychiatry 2022; 22:508. [PMID: 35902841 PMCID: PMC9331580 DOI: 10.1186/s12888-022-04123-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient accessible electronic health records (PAEHR) hold the potential to increase patient empowerment, especially for patients with complex, long-term or chronic conditions. However, evidence of its benefits for patients who undergo mental health treatment is unclear and inconsistent, and several concerns towards use of PAEHR emerged among health professionals. This study aimed at exploring the impact of PAEHR among mental health professionals in terms of patient-provider relationship, changes in the way of writing in the electronic health records and reasons for denying access to information. METHODS In-depth qualitative interviews with health professionals working in two mental health outpatient clinics at Helgelandssykehuset in Northern Norway, one of the first hospitals in Norway to implement the PAEHR in 2015. The interviews were conducted by phone or videoconferencing, audio recorded and transcribed verbatim. Data were analyzed by a multidisciplinary research team using the Framework Method. RESULTS A total of 16 in-depth qualitative interviews were conducted in April and May 2020. The PAEHR implemented in Norway was seen as a tool to increase transparency and improve the patient-provider relationship. The PAEHR was seen to have negative consequences only in limited situations, such as for patients with severe mental conditions, for child protective services when parents access their children's journal, or for patients with abusive partners. The functionality to deny access to the journal was used rarely. A more common practice for making information not immediately available was to delay the final approval of the notes. The documentation practices changed over the years, but it was not clear to what extent the changes were attributable to the introduction of the PAEHR. Health professionals write their notes keeping in mind that patients might read them, and they try to avoid unclear language, information about third parties, and hypotheses that might create confusion. CONCLUSIONS The concerns voiced by mental health professionals regarding the impact of the PAEHR on the patient-provider relationship and practices to deny access to information were not supported by the results of this study. Future research should explore changes in documentation practices by analysing the content of the electronic health records.
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Affiliation(s)
- Paolo Zanaboni
- Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway. .,Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
| | - Eli Kristiansen
- grid.412244.50000 0004 4689 5540Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway
| | - Ove Lintvedt
- grid.412244.50000 0004 4689 5540Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway
| | - Rolf Wynn
- grid.10919.300000000122595234Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway
| | - Monika A. Johansen
- grid.412244.50000 0004 4689 5540Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway
| | | | - Asbjørn J. Fagerlund
- grid.412244.50000 0004 4689 5540Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway
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6
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Posada J, Potvin H, Cookson C. Opening Up with Open Notes: Writing Notes in the Era of Full Patient Access. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:259-263. [PMID: 34309805 DOI: 10.1007/s40596-021-01510-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/06/2021] [Indexed: 06/13/2023]
Affiliation(s)
| | - Hannah Potvin
- University of California San Francisco, San Francisco, CA, USA
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7
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Chan CA, Tetrault JM, Fiellin DA, Weimer MB. SOAPs and SUDs: Patients With Substance Use Disorders and What Clinicians Should Know About the Cures Act. J Addict Med 2022; 16:141-142. [PMID: 34049315 DOI: 10.1097/adm.0000000000000879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The 21st Century Cures Act of 2016 mandates that patients have access to their clinical notes, labs, and imaging through electronic portals and requires information sharing among healthcare entities. We provide practical tips to healthcare professionals on best practices in documenting substance use in the era of transparent electronic medical records, as well as provide guidance on the application of the Cures Act information blocking exceptions for their patients who use substances.
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Affiliation(s)
- Carolyn A Chan
- Program in Addiction Medicine, Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT
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Jackson SL, Shucard H, Liao JM, Bell SK, Fossa A, Payne TH, Reisch LM, Radick AC, DesRoches CM, Fitzgerald P, Leveille S, Walker J, Elmore JG. Care partners reading patients' visit notes via patient portals: Characteristics and perceptions. PATIENT EDUCATION AND COUNSELING 2022; 105:290-296. [PMID: 34481675 DOI: 10.1016/j.pec.2021.08.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 07/23/2021] [Accepted: 08/20/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Care partners are key members of patients' health care teams, yet little is known about their experiences accessing patient information via electronic portals. OBJECTIVE To better understand the characteristics and perceptions of care partners who read patients' electronic visit notes. PATIENT INVOLVEMENT Focus groups with diverse patients from a community health center provided input into survey development. METHODS We contacted patient portal users at 3 geographically distinct sites in the US via email in 2017 for an online survey including open ended questions which we qualitatively analyzed. RESULTS Respondents chose whether to answer as care partners (N = 874) or patients (N = 28,782). Among care partner respondents, 44% were spouses, 43% children/other family members, and 14% friends/neighbors/other. Both care partners and patients reported that access to electronic notes was very important for promoting positive health behaviors, but care partners' perceptions of importance were consistently more positive than patients' perceptions of engagement behaviors. Open-ended comments included positive benefits such as: help with remembering the plan for care, coordinating care with other doctors, decreasing stress of care giving, improving efficiency of visits, and supporting patients from a geographical distance. They also offered suggestions for improving electronic portal and note experience for care partners such as having a separate log on for care partners; having doctors avoid judgmental language in their notes; and the ability to prompt needed medical care for patients. DISCUSSION Care partners value electronic access to patients' health information even more than patients. The majority of care partners were family members, whose feedback is important for improving portal design that effectively engages these care team members. PRACTICAL VALUE Patient care in the time of COVID-19 increasingly requires social distancing which may place additional burden on care partners supporting vulnerable patients. Access to patient notes may promote quality of care by keeping care partners informed, and care partner's input should be used to optimize portal design and electronic access to patient information.
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Affiliation(s)
- Sara L Jackson
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA.
| | - Hannah Shucard
- Department of Biostatistics, University of Washington School of Medicine, Seattle, WA, USA
| | - Joshua M Liao
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Sigall K Bell
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Alan Fossa
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Thomas H Payne
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Lisa M Reisch
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Andrea C Radick
- Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | | | - Patricia Fitzgerald
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Suzanne Leveille
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jan Walker
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Joann G Elmore
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
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9
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van Rijt AM, Hulter P, Weggelaar-Jansen AM, Ahaus K, Pluut B. Mental Health Care Professionals' Appraisal of Patients' Use of Web-Based Access to Their Electronic Health Record: Qualitative Study. J Med Internet Res 2021; 23:e28045. [PMID: 34448705 PMCID: PMC8433850 DOI: 10.2196/28045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 06/16/2021] [Accepted: 07/05/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Patients in a range of health care sectors can access their medical health records using a patient portal. In mental health care, the use of patient portals among mental health care professionals remains low. Mental health care professionals are concerned that patient access to electronic health records (EHRs) will negatively affect the patient's well-being and privacy as well as the professional's own workload. OBJECTIVE This study aims to provide insights into the appraisal work of mental health care professionals to assess and understand patient access to their EHRs through a patient portal. METHODS We conducted a qualitative study that included 10 semistructured interviews (n=11) and a focus group (n=10). Participants in both the interviews and the focus group were mental health care professionals from different professional backgrounds and staff employees (eg, team leaders and communication advisors). We collected data on their opinions and experiences with the recently implemented patient portal and their attempts to modify work practices. RESULTS Our study provides insights into mental health care professionals' appraisal work to assess and understand patient access to the EHR through a patient portal. A total of four topics emerged from our data analysis: appraising the effect on the patient-professional relationship, appraising the challenge of sharing and registering delicate information, appraising patient vulnerability, and redefining consultation routines and registration practices. CONCLUSIONS Mental health care professionals struggle with the effects of web-based patient access and are searching for the best ways to modify their registration and consultation practices. Our participants seem to appraise the effects of web-based patient access individually. Our study signals the lack of systematization and communal appraisal. It also suggests various solutions to the challenges faced by mental health care professionals. To optimize the effects of web-based patient access to EHRs, mental health care professionals need to be involved in the process of developing, implementing, and embedding patient portals.
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Affiliation(s)
| | - Pauline Hulter
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Anne Marie Weggelaar-Jansen
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands.,Eindhoven University of Technology, Eindhoven, Netherlands
| | - Kees Ahaus
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
| | - Bettine Pluut
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
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10
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Jonnergård K, Petersson L, Erlingsdóttir G. Communicating the Implementation of Open Notes to Health Care Professionals: Mixed Methods Study. JMIR Med Inform 2021; 9:e22391. [PMID: 34398794 PMCID: PMC8406101 DOI: 10.2196/22391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/15/2020] [Accepted: 07/02/2021] [Indexed: 12/04/2022] Open
Abstract
Background The literature on how to communicate reform in organizations has mainly focused on levels of hierarchy and has largely ignored the variety of professions that may be found within an organization. In this study, we focus on the relationship between media type and professional responses. Objective The objective of this study was to investigate whether and how belonging to a profession influences the choice of communication media and the perception of information when a technical innovation is implemented in a health care setting. Methods This study followed a mixed methods design based on observations and participant studies, as well as a survey of professionals in psychiatric health care in Sweden. The χ2 test was used to detect differences in perceptions between professional groups. Results The use of available communication media differed among professions. These differences seem to be related to the status attached to each profession. The sense-making of the information appears to be similar among the professions, but is based on their traditional professional norms rather than on reflection on the reform at hand. Conclusions When communicating about the implementation of a new technology, the choice of media and the message need to be attuned to the employees in both hierarchical and professional terms. This also applies to situations where professional employees are only indirectly affected by the implementation. A differentiated communication strategy is preferred over a downward cascade of information.
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Affiliation(s)
- Karin Jonnergård
- Department of Business Administration, Lund University, Lund, Sweden
| | - Lena Petersson
- Department of Design Sciences, Lund University, Lund, Sweden
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11
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Fogler JM, Ratliff-Schaub K, McGuinn L, Crutchfield P, Schwartz J, Soares N. OpenNotes: Anticipatory Guidance and Ethical Considerations for Pediatric Psychologists in Interprofessional Settings. J Pediatr Psychol 2021; 47:189-194. [PMID: 34383944 DOI: 10.1093/jpepsy/jsab091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/24/2021] [Accepted: 07/26/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The 21st Century Cures Act included an "OpenNotes" mandate to foster transparent communication among patients, families, and clinicians by offering rapid electronic access to clinical notes. This article seeks to address concerns about increased documentation burden, vulnerability to patient complaints, and other unforeseen consequences of patients having near-real-time access to their records. METHODS This topical review explores both extant literature, and case examples from the authors' direct experience, about potential responses/reactions to OpenNotes. RESULTS The ethics of disclosing medical information calls for nuanced approaches: Although too little access can undermine a patient's autonomy and the capacity for truly egalitarian shared decision-making, unfettered access to all medical information has significant potential to harm them. Suggested strategies for mitigating risks in premature disclosure include patient and provider education and "modularizing" sensitive information in notes. CONCLUSION The OpenNotes era has ushered in the possibilities of greater patient and family collaboration in shared decision-making and reduced barriers to documentation sharing. However, it has raised new ethical and clinician documentation considerations. In addition to clinician education, patients and families could benefit from education around the purpose of clinical documentation, how to utilize OpenNotes, and the benefits of engaging in dialogue regarding the content and tone of documentation.
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Affiliation(s)
- Jason M Fogler
- Boston Children's Hospital and Harvard Medical School, USA
| | - Karen Ratliff-Schaub
- Prisma Health and University of South Carolina School of Medicine Greenville, USA
| | | | | | | | - Neelkamal Soares
- Western Michigan University Homer Stryker M.D. School of Medicine, USA
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12
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Zhang T, Shen N, Booth R, LaChance J, Jackson B, Strudwick G. Supporting the use of patient portals in mental health settings: a scoping review. Inform Health Soc Care 2021; 47:62-79. [PMID: 34032528 DOI: 10.1080/17538157.2021.1929998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
With the increased use of patient portals in acute and chronic care settings as a strategy to support patient care and improve patient-centric care, there is still little known about the impact of patient portals in mental health contexts. The purposes of this review were to: 1) identify the critical success factors for successful patient portal implementation and adoption among end-users that could be utilized in a mental health setting; 2) uncover what we know about existing mental health portals and their effectiveness for end-users; and 3) determine what indicators are being used to evaluate existing patient portals for end-users that may be applied in a mental health context. This scoping review was conducted through a search of six electronic databases including Medline, EMBASE, PsycINFO, and CINAHL for articles published between 2007 and 2021. A total of 31 articles were included in the review. Critical success factors of patient portal implementation included those related to education, usefulness, usability, culture, and resources. Only two patient portals had articles published related to their effectiveness for end-users (one in Canada and the other in the United States). More than 100 measures of process (n = 73) and outcome (n = 59) indicators were extracted from the studies and mapped to the Benefits Evaluation Framework. Patient portals carry great potential to improve patient care, but more attention needs to be given to ensure they are being evaluated through the development and implementation phases with the end-users in mind. Further understanding of process indicators relating to use are essential for long-term patient adoption of portals to obtain their potential benefits.
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Affiliation(s)
- Timothy Zhang
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nelson Shen
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, ON, Canada
| | - Richard Booth
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Jessica LaChance
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada
| | - Brianna Jackson
- Arthur Labatt Family School of Nursing, Western University, London, ON, Canada.,Yale School of Nursing, Yale University, Orange, Connecticut, USA
| | - Gillian Strudwick
- Centre for Addiction and Mental Health, Campbell Family Mental Health Research Institute, Toronto, ON, Canada
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13
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Smith CM, Stavig A, McCann P, Moskovich AA, Merwin RM. "Let's Talk About Your Note": Using Open Notes as an Acceptance and Commitment Therapy Based Intervention in Mental Health Care. Front Psychiatry 2021; 12:704415. [PMID: 34349686 PMCID: PMC8328223 DOI: 10.3389/fpsyt.2021.704415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Colin M Smith
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States.,Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Alissa Stavig
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States.,Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Peter McCann
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States.,Department of Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Ashley A Moskovich
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Rhonda M Merwin
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, United States
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14
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DesRoches CM. Healthcare in the new age of transparency. Semin Dial 2020; 33:533-538. [PMID: 33210371 DOI: 10.1111/sdi.12934] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/20/2020] [Indexed: 12/16/2022]
Abstract
Debates around access to and ownership of an individual's digital information have taken center stage in health care. A decade ago, the idea of offering patients ready access to their clinical notes was a fringe idea. Today, information transparency in health care is a pressing legislative and regulatory issue in the United States and elsewhere. The 21st Century Cures Act of 2016 requires that clinicians and health care organizations give patients electronic access to the information in their electronic medical records. Rules to enact this legislative priority by the Office of the National Coordinator for Health Information Technology and the Centers for Medicare and Medicaid Services substantially expanded the types of information that must be easily accessible to patients and exchanged among clinicians in electronic form. A growing body of research supports the notion that sharing transparent medical records, including clinical notes with patients, can help to strengthen communication, trust in clinicians, and patient engagement. Patients receiving dialysis may receive particular benefits from this greater transparency due to their increased risk for fragmented care. In the paper, we review the decade of research focused on the effects of sharing clinical notes with patients and the implications for improved engagement and care.
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15
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Blease CR, O'Neill S, Walker J, Hägglund M, Torous J. Sharing notes with mental health patients: balancing risks with respect. Lancet Psychiatry 2020; 7:924-925. [PMID: 32059796 DOI: 10.1016/s2215-0366(20)30032-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/18/2019] [Accepted: 01/10/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Charlotte R Blease
- OpenNotes, Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
| | - Stephen O'Neill
- OpenNotes, Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Jan Walker
- OpenNotes, Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Maria Hägglund
- OpenNotes, Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
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16
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Parsons CR, Hron JD, Bourgeois FC. Preserving privacy for pediatric patients and families: use of confidential note types in pediatric ambulatory care. J Am Med Inform Assoc 2020; 27:1705-1710. [PMID: 32989446 DOI: 10.1093/jamia/ocaa202] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 08/05/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study evaluates and characterizes the use of a confidential clinic note type as part of the implementation of open notes at a free-standing children's hospital. We describe how this electronic health record feature which disables patient and family access to selected notes in the patient portal is used across our institution, which clinicians are using this feature, and the type of data our clinicians consider confidential. MATERIALS AND METHODS Through retrospective chart review, we have evaluated the use of a confidential note type over a 1-year period. RESULTS We identified 402 964 clinic notes created during a 1-year period, of which 9346 (2.3%) were flagged as confidential. Use of this confidential note type was associated with female patient sex and increase in patient age. It was used most frequently by a small subset of providers. 922 (83.8%) of 1100 notes manually reviewed contained sensitive information. Reasons for confidential notes varied, but patient's mental health was most commonly identified. DISCUSSION Our data demonstrate variability in the use of a confidential note type across specialties, patient ages, and types of confidential information. This note type is frequently utilized by a subset of providers who often manage sensitive patient and parent information. As vendors and institutions enable open notes, thoughtful implementation and provider education surrounding the use of this confidential feature is needed. CONCLUSION A confidential clinic note feature is an integral aspect of pediatric open notes implementation. This feature supports protection of confidential information pertaining to our patients and their caregivers.
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Affiliation(s)
- Chase R Parsons
- Boston Children's Hospital, Division of General Pediatrics Boston, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan D Hron
- Boston Children's Hospital, Division of General Pediatrics Boston, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Fabienne C Bourgeois
- Boston Children's Hospital, Division of General Pediatrics Boston, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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17
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Blease CR, Walker J, Torous J, O'Neill S. Sharing Clinical Notes in Psychotherapy: A New Tool to Strengthen Patient Autonomy. Front Psychiatry 2020; 11:527872. [PMID: 33192647 PMCID: PMC7655789 DOI: 10.3389/fpsyt.2020.527872] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 09/22/2020] [Indexed: 01/27/2023] Open
Affiliation(s)
- Charlotte R. Blease
- OpenNotes, General Medicine and Primary Care Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Jan Walker
- OpenNotes, General Medicine and Primary Care Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
| | - Stephen O'Neill
- OpenNotes, General Medicine and Primary Care Research, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, United States
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18
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Strudwick G, Booth RG, McLean D, Leung K, Rossetti S, McCann M, Strauss J. Identifying indicators of meaningful patient portal use by psychiatric populations. Inform Health Soc Care 2020; 45:396-409. [DOI: 10.1080/17538157.2020.1776291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Gillian Strudwick
- Centre for Addiction and Mental Health, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Richard G. Booth
- Arthur Labatt Family School of Nursing, Western University, London, Canada
| | - Drew McLean
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Kevin Leung
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Sarah Rossetti
- Department of Biomedical Informatics and Nursing, Columbia University, New York, New York, USA
| | - Miriam McCann
- Centre for Addiction and Mental Health, Toronto, Canada
| | - John Strauss
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
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19
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Mehta S, Jamieson T, Ackery AD. Helping clinicians and patients navigate electronic patient portals: ethical and legal principles. CMAJ 2020; 191:E1100-E1104. [PMID: 31591096 DOI: 10.1503/cmaj.190413] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- S Mehta
- Division of Emergency Medicine (Mehta, Ackery), Department of Medicine, University of Toronto; Division of General Internal Medicine (Jamieson), St. Michael's Hospital; Institute for Health System Solutions and Virtual Care (WIHV) (Jamieson), Women's College Hospital; Department of Emergency Medicine (Ackery), St. Michael's Hospital, Toronto, Ont
| | - T Jamieson
- Division of Emergency Medicine (Mehta, Ackery), Department of Medicine, University of Toronto; Division of General Internal Medicine (Jamieson), St. Michael's Hospital; Institute for Health System Solutions and Virtual Care (WIHV) (Jamieson), Women's College Hospital; Department of Emergency Medicine (Ackery), St. Michael's Hospital, Toronto, Ont
| | - A D Ackery
- Division of Emergency Medicine (Mehta, Ackery), Department of Medicine, University of Toronto; Division of General Internal Medicine (Jamieson), St. Michael's Hospital; Institute for Health System Solutions and Virtual Care (WIHV) (Jamieson), Women's College Hospital; Department of Emergency Medicine (Ackery), St. Michael's Hospital, Toronto, Ont.
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20
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Chimowitz H, O'Neill S, Leveille S, Welch K, Walker J. Sharing Psychotherapy Notes with Patients: Therapists' Attitudes and Experiences. SOCIAL WORK 2020; 65:159-168. [PMID: 32236447 DOI: 10.1093/sw/swaa010] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/21/2019] [Accepted: 04/08/2019] [Indexed: 06/11/2023]
Abstract
Evidence suggests that the practice of sharing clinicians' notes with patients via online patient portals may increase patient engagement and improve patient-clinician relationships while requiring little change in providers' workflow. Authors examined clinical social workers' experiences and attitudes related to open psychotherapy notes using focus groups and telephone interviews. Twenty-four of 29 eligible therapists agreed to open their notes to patients, and nine participated in this study. Participants were generally positive about their experiences and reported few disruptions to their workload or practice. However, they were hesitant to bring up notes to patients during sessions, and they discussed the benefits of open therapy notes mostly hypothetically. The five therapists who did not share notes worried that open notes would be detrimental to therapeutic relationships, patient well-being, and workflow. However, the concern they discussed most often related to the electronic health record rather than to open notes, because therapy notes are visible to all authorized clinicians as part of the general medical record. Future research is needed to deepen our understanding of the risks and benefits of open psychotherapy notes and to inform development of training programs to support therapists in opening notes.
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21
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Shen N, Sequeira L, Silver MP, Carter-Langford A, Strauss J, Wiljer D. Patient Privacy Perspectives on Health Information Exchange in a Mental Health Context: Qualitative Study. JMIR Ment Health 2019; 6:e13306. [PMID: 31719029 PMCID: PMC6881785 DOI: 10.2196/13306] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 06/14/2019] [Accepted: 08/31/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The privacy of patients with mental health conditions is prominent in health information exchange (HIE) discussions, given that their potentially sensitive personal health information (PHI) may be electronically shared for various health care purposes. Currently, the patient privacy perspective in the mental health context is not well understood because of the paucity of in-depth patient privacy research; however, the evidence suggests that patient privacy perspectives are more nuanced than what has been assumed in the academic and health care community. OBJECTIVE This study aimed to generate an understanding on how patients with mental health conditions feel about privacy in the context of HIE in Canada. This study also sought to identify the factors underpinning their privacy perspectives and explored how their perspectives influenced their attitudes toward HIE. METHODS Semistructured interviews were conducted with patients at a Canadian academic hospital for addictions and mental health. Guided by the Antecedent-Privacy Concern-Outcome macro-model, interview transcripts underwent deductive and inductive thematic analyses. RESULTS We interviewed 14 participants. Their privacy concerns varied, depending on the participant's privacy experiences and health care perceptions. Media reports of privacy breaches and hackers had little impact on participants' privacy concerns because of a fatalistic belief that privacy breaches are a reality in the digital age. Rather, direct observations and experiences with the mistreatment of PHI in health care settings caused concern. Decisions to trust others with PHI depended on past experiences with the individual (or institution) and health care needs. Participants had little knowledge of patient privacy rights and legislation but were willing to participate in HIE because of perceived individual and societal benefits. CONCLUSIONS This study introduces evidence that patients with mental health conditions would support HIE. Participants were pragmatic, supporting HIE because they wanted the best care possible. They also understood that their PHI was critical in supporting the single-payer Canadian health care system. Participant health care experiences informed their privacy perspectives, trust, and PHI sharing attitudes-all accentuating the importance of the patient experience in building trust in HIE. Their lack of knowledge about patient rights and PHI uses highlights the degree of trust they have in the health care system to protect their privacy. These findings suggest that the patient privacy discourse should extend beyond the oft-cited barrier of patient privacy concerns to include discussions about building trust, communicating the benefits of HIE, and improving patient experiences. Although our findings are in the Canadian context, this study highlights the importance of engaging patients in privacy policy discussions, regardless of jurisdiction, to ensure their nuanced perspectives are reflected in policy decisions on their PHI.
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Affiliation(s)
- Nelson Shen
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Lydia Sequeira
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Michelle Pannor Silver
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Interdisciplinary Centre for Health and Society, University of Toronto Scarborough, Scarborough, ON, Canada
| | | | - John Strauss
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - David Wiljer
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
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22
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Galvin HK, Petersen C, Subbian V, Solomonides A. Patients as Agents in Behavioral Health Research and Service Provision: Recommendations to Support the Learning Health System. Appl Clin Inform 2019; 10:841-848. [PMID: 31694055 PMCID: PMC6834452 DOI: 10.1055/s-0039-1700536] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 08/28/2019] [Indexed: 12/29/2022] Open
Abstract
Authentic inclusion and engagement of behavioral health patients in their care delivery and in the process of scientific discovery are often challenged in the health care system. Consequently, there is a growing need to engage with and better serve the needs of behavioral health patients, particularly by leveraging health information technologies. In this work, we present rationale and strategies for improving patient engagement in this population in research and clinical care. First, we describe the potential for creating meaningful patient-investigator partnerships in behavioral health research to allow for cocreation of knowledge with patients. Second, in the context of behavioral health services, we explore the utility of sharing clinical notes to promote patients' agency in care delivery. Both lines of inquiry are centered in a Learning Health System model for behavioral health, where patients are agents in enhancing the therapeutic alliance and advancing the process of knowledge generation. Recommendations include genuinely democratizing the health care system and biomedical research enterprise through patient-centered information technologies such as patient portals. In research and technology development, we recommend seeking and tailoring behavioral health patients' involvement to their abilities, promoting patient input in data analysis plans, evaluating research and informatics initiatives for patients and clinicians, and sharing success and research findings with patients. In clinical practice, we recommend encouraging patients to read behavioral health notes on portals, engaging in proactive communication regarding note content, assessing outcomes including stress and anxiety in response to note content, and working with technology providers to support note-sharing governance and deployment.
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Affiliation(s)
| | - Carolyn Petersen
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, United States
| | - Vignesh Subbian
- Department of Biomedical Engineering, University of Arizona, Tucson, Arizona, United States
| | - Anthony Solomonides
- Department of Systems and Industrial Engineering, University of Arizona, Tucson, Arizona, United States
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23
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Erlingsdóttir G, Petersson L, Jonnergård K. A Theoretical Twist on the Transparency of Open Notes: Qualitative Analysis of Health Care Professionals' Free-Text Answers. J Med Internet Res 2019; 21:e14347. [PMID: 31573905 PMCID: PMC6785719 DOI: 10.2196/14347] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/28/2019] [Accepted: 08/18/2019] [Indexed: 11/22/2022] Open
Abstract
Background The New Public Management movement strove for transparency so that policy makers and citizens could gain insight into the work and performance of health care. As the use of the electronic health record (EHR) started to diffuse, a foundation was laid for enhanced transparency within and between health care organizations. Now we appear to be experiencing a new kind of transparency in the health care sector. Many health care providers offer their patients online access to their EHRs (here referred to as Open Notes). The Open Notes system enables and strives for transparency between the health care organization and the patient. Hence, this study investigates health care professional (HCP) perceptions of Open Notes and deepens the understanding of the transparency that Open Notes implies. Objective Based on two survey studies of HCP perceptions of Open Notes, this paper aims to deepen the academic writing on the type of transparency that is connected to Open Notes. Methods HCPs in adult psychiatry in Region Skåne, Sweden, were surveyed before and after implementation of Open Notes. The empirical material presented consists of 1554 free-text answers from two Web surveys. A qualitative content analysis was performed. Results The theoretically informed analysis pivots around the following factors connected to transparency: effectiveness; trust; accountability; autonomy and control; confidentiality, privacy, and anonymity; fairness; and legitimacy. The results show that free-text answers can be sorted under these factors as trade-offs with transparency. According to HCPs, trade-offs affect their work, their relationship with patients, and not least, their work tool, the EHR. However, since many HCPs also state that they have not met many patients, and in some cases none, who have read their EHRs, these effects seem to be more connected to the possibility (or threat) of transparency than to the actual effectuated transparency. Conclusions The implementation (or reform) of Open Notes is policy driven while demanding real-time transparency on behalf of citizens/patients and not the authorities, which makes this particular form of transparency quite unique and interesting. We have chosen to call it governed individual real-time transparency. The effects of Open Notes may vary between different medical specialties relative to their sensitivity to both total and real-time transparency. When HCPs react by changing their ways of writing notes, Open Notes can affect the efficiency of the work of HCPs and the service itself in a negative manner. HCP reactions are aimed primarily at protecting patients and their relatives as well as their own relationship with the patients and secondly at protecting themselves. Thus, governed individual real-time transparency that provides full transparency of an actual practice in health care may have the intended positive effects but can also result in negative trade-offs between transparency and efficiency of the actual practice. This may imply that full transparency is not always most desirable but that other options can be considered on a scale between none and full transparency.
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Affiliation(s)
| | - Lena Petersson
- Department of Design Sciences, Lund University, Lund, Sweden
| | - Karin Jonnergård
- Department of Business Administration, Lund University, Lund, Sweden
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24
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Blease CR, Bell SK. Patients as diagnostic collaborators: sharing visit notes to promote accuracy and safety. Diagnosis (Berl) 2019; 6:213-221. [DOI: 10.1515/dx-2018-0106] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 04/08/2019] [Indexed: 12/21/2022]
Abstract
Abstract
Error resulting from missed, delayed, or wrong diagnoses is estimated to occur in 10–15% of ambulatory and inpatient encounters, leading to serious harm in around half of such cases. When it comes to conceptualizing diagnostic error, most research has focused on factors pertaining to: (a) physician cognition and (b) ergonomic or systems factors related to the physician’s working environment. A third factor – the role of patients in diagnostic processes – remains relatively under-investigated. Yet, as a growing number of researchers acknowledge, patients hold unique knowledge about themselves and their healthcare experience, and may be the most underutilized resource for mitigating diagnostic error. This opinion article examines recent findings from patient surveys about sharing visit notes with patients online. Drawing on these survey results, we suggest three ways in which sharing visit notes with patients might enhance diagnostic processes: (1) avoid delays and missed diagnoses by enhancing timely follow up of recommended tests, results, and referrals; (2) identify documentation errors that may undermine diagnostic accuracy; and (3) strengthen patient-clinician relationships thereby creating stronger bidirectional diagnostic partnerships. We also consider the potential pitfalls or unintended consequences of note transparency, and highlight areas in need of further research.
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25
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O’Neill S, Chimowitz H, Leveille S, Walker J. Embracing the new age of transparency: mental health patients reading their psychotherapy notes online. J Ment Health 2019; 28:527-535. [DOI: 10.1080/09638237.2019.1644490] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Stephen O’Neill
- BIDMC Social Work Department, Harvard Medical School, Boston, MA, USA
| | - Hannah Chimowitz
- BIDMC Division of General Medicine, Harvard Medical School, Boston, MA, USA
| | - Suzanne Leveille
- BIDMC Division of General Medicine, Harvard Medical School, Boston, MA, USA
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA, USA
| | - Jan Walker
- BIDMC Division of General Medicine, Harvard Medical School, Boston, MA, USA
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26
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Strudwick G, Yeung A, Gratzer D. Easy Access, Difficult Consequences? Providing Psychiatric Patients With Access to Their Health Records Electronically. Front Psychiatry 2019; 10:917. [PMID: 31920763 PMCID: PMC6926439 DOI: 10.3389/fpsyt.2019.00917] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 11/18/2019] [Indexed: 11/29/2022] Open
Affiliation(s)
- Gillian Strudwick
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Anthony Yeung
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - David Gratzer
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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27
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Pisciotta M, Denneson LM, Williams HB, Woods S, Tuepker A, Dobscha SK. Providing mental health care in the context of online mental health notes: advice from patients and mental health clinicians. J Ment Health 2018; 28:64-70. [PMID: 30468100 DOI: 10.1080/09638237.2018.1521924] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND The OpenNotes initiative provides patients online access to their clinical notes. Mental health clinicians in the Veterans Health Administration report a need for guidance on how to provide care, write notes, and discuss them in the context of OpenNotes. AIM To provide mental health clinicians recommendations identified by patients and clinicians that help them effectively practice in the context of OpenNotes. METHOD Twenty-eight mental health clinicians and 28 patients in mental health care participated in semi-structured interviews about their experiences and perceptions with OpenNotes. A rapid review approach was used to analyze transcripts. RESULTS Analysis of interviews identified three domains of advice for mental health clinicians: writing notes that maintain the therapeutic relationship, communicating with patients about their notes and utilizing clinical notes as a patient resource to enhance care. Specific recommendations are provided. CONCLUSION Findings provide mental health clinicians with guidance from service users and clinicians on how to leverage clinical notes to maintain - and potentially enhance -therapeutic relationships in a healthcare system in which patients are able to read their mental health notes online.
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Affiliation(s)
- Maura Pisciotta
- a Center to Improve Veteran Involvement in Care (CIVIC) , VA Portland Health Care System , Portland , OR , USA
| | - Lauren M Denneson
- a Center to Improve Veteran Involvement in Care (CIVIC) , VA Portland Health Care System , Portland , OR , USA.,b Department of Psychiatry , Oregon Health & Science University , Portland , OR , USA
| | - Holly B Williams
- a Center to Improve Veteran Involvement in Care (CIVIC) , VA Portland Health Care System , Portland , OR , USA
| | - Susan Woods
- c Center for Outcomes Research & Evaluation , Maine Medical Center , Portland , ME , USA
| | - Anais Tuepker
- a Center to Improve Veteran Involvement in Care (CIVIC) , VA Portland Health Care System , Portland , OR , USA
| | - Steven K Dobscha
- a Center to Improve Veteran Involvement in Care (CIVIC) , VA Portland Health Care System , Portland , OR , USA.,b Department of Psychiatry , Oregon Health & Science University , Portland , OR , USA
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28
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Clinical Nurse Specialists' Perceptions of a Mental Health Patient Portal. CLIN NURSE SPEC 2018; 32:313-322. [PMID: 30299334 DOI: 10.1097/nur.0000000000000406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purposes of this study were to explore clinical nurse specialists' views of the potential influence of a mental health portal on nursing practice and to identify portal implementation strategies. METHODS A qualitative descriptive approach was used. Semistructured interviews were conducted with 5 clinical nurse specialists. Two independent coders conducted an inductive content analysis of the transcribed interviews to generate codes describing patterns in the data to identify originating themes. RESULTS The content analysis uncovered the following 4 themes: (1) implementation strategies, (2) nurse likelihood to recommend, (3) impact on nursing practice, and (4) perceived influence on patients. CONCLUSION Direct care nurses may benefit from education and coaching on how to document in the record using patient-centered language that is understandable to patients who may be reading it. In addition, the use of patient portals should be designed to fit into nurses' existing clinical workflows. Finally, more research is needed to identify the benefits and unintended consequences of patient portals within a mental health context.
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29
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Keough L, Wright J, Watson B, Nixon-Silberg T, Leveille S, Halon PA. Student-accessible healthcare records: A mixed-methods study of college student and provider. Health Informatics J 2018; 24:293-308. [PMID: 30068265 DOI: 10.1177/1460458216673775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This mixed methods study evaluated student and provider attitudes and expectations about offering students online access to their student health services visit notes (open notes). Six (N=6) health care providers from four public universities in northeastern Massachusetts participated. Qualitative interviews were completed by students (N=14) from one University in fall of 2013 and an online survey was completed at two universities in Spring of 2014. Attitudes and expectations were explored using qualitative data and descriptive statistics were used to analyze survey questions. Students' interviews revealed that they desire control over their health and open notes would give them insight and involvement in their health care. Survey data supported these themes. In contrast, providers worried about how it could impact provider-patient relationships. Open notes has the potential to promote students' understanding and responsibility for their healthcare, which could assist students in their transition from pediatric to adult health care.
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Affiliation(s)
- Lori Keough
- University of Massachusetts Lowell, USA.,University of Massachusetts Boston, USA
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30
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Klein JW, Peacock S, Tsui JI, O'Neill SF, DesRoches CM, Elmore JG. Perceptions of Primary Care Notes by Patients With Mental Health Diagnoses. Ann Fam Med 2018; 16:343-345. [PMID: 29987083 PMCID: PMC6037508 DOI: 10.1370/afm.2287] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 01/05/2018] [Accepted: 02/14/2018] [Indexed: 11/09/2022] Open
Abstract
There are concerns regarding whether patients with mental illness should be provided with access to their electronic medical records. This study compared perceptions of patients with (n = 400) and without (n = 2,134) a mental health diagnosis regarding access to primary care clinic notes through secure online portals. Eligible participants viewed at least 1 clinic note during a 12-month period. Administrative data were used to stratify patients by mental health diagnosis. As we hypothesized, patients with and without mental health diagnoses had similar perceptions about online access to notes.
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Affiliation(s)
- Jared W Klein
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Sue Peacock
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Judith I Tsui
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington
| | - Stephen F O'Neill
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | | | - Joann G Elmore
- David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California
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Bourgeois FC, DesRoches CM, Bell SK. Ethical Challenges Raised by OpenNotes for Pediatric and Adolescent Patients. Pediatrics 2018; 141:peds.2017-2745. [PMID: 29776979 DOI: 10.1542/peds.2017-2745] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2017] [Indexed: 11/24/2022] Open
Abstract
Sharing clinic notes online with patients and parents may yield many potential benefits to patients and providers alike, but the unprecedented transparency and accessibility to notes afforded by patient portals has also raised a number of unique ethical and legal concerns. As the movement toward transparent notes (OpenNotes) grows, clinicians and health care organizations caring for pediatric and adolescent patients wrestle with how to document confidential and sensitive information, including issues such as reproductive health, misattributed paternity, or provider and parent disagreements. With OpenNotes now reaching >21 000 000 US patients, pediatricians continue to query best portal practices. In this Ethics Rounds, we discuss 3 illustrative cases highlighting common pediatric OpenNotes concerns and provide guidance for organizations and clinicians regarding documentation practices and patient portal policies to promote patient engagement and information transparency while upholding patient and parent confidentiality and the patient- and/or parent-provider relationship.
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Affiliation(s)
- Fabienne C Bourgeois
- Division of General Pediatrics, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Catherine M DesRoches
- Department of Medicine, Beth Israel Deaconess Medical Center, and Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Sigall K Bell
- Department of Medicine, Beth Israel Deaconess Medical Center, and Department of Medicine, Harvard Medical School, Boston, Massachusetts
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Petersson L, Erlingsdóttir G. Open Notes in Swedish Psychiatric Care (Part 1): Survey Among Psychiatric Care Professionals. JMIR Ment Health 2018; 5:e11. [PMID: 29396386 PMCID: PMC5816262 DOI: 10.2196/mental.9140] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 12/20/2017] [Accepted: 01/08/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND When the Swedish version of Open Notes, an electronic health record (EHR) service that allows patients online access, was introduced in hospitals, primary care, and specialized care in 2012, psychiatric care was exempt. This was because psychiatric notes were considered too sensitive for patient access. However, as the first region in Sweden, Region Skåne added adult psychiatry to its Open Notes service in 2015. This made it possible to carry out a unique baseline study to investigate how different health care professionals (HCPs) in adult psychiatric care in the region expect Open Notes to impact their patients and their practice. This is the first of two papers about the implementation of Open Notes in adult psychiatric care in Region Skåne. OBJECTIVE The objective of this study was to describe, compare, and discuss how different HCPs in adult psychiatric care in Region Skåne expect Open Notes to impact their patients and their own practice. METHODS A full population Web-based questionnaire was distributed to psychiatric care professionals in Region Skåne in late 2015. The response rate was 28.86% (871/3017). Analyses show that the respondents were representative of the staff as a whole. A statistical analysis examined the relationships between different professionals and attitudes to the Open Notes service. RESULTS The results show that the psychiatric HCPs are generally of the opinion that the service would affect their own practice and their patients negatively. The most striking result was that more than 60% of both doctors (80/132, 60.6%) and psychologists (55/90, 61%) were concerned that they would be less candid in their documentation in the future. CONCLUSIONS Open Notes can increase the transparency between patients and psychiatric HCPs because patients are able to access their EHRs online without delay and thus, can read notes that have not yet been approved by the responsible HCP. This may be one explanation as to why HCPs are concerned that the service will affect both their own work and their patients.
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Affiliation(s)
- Lena Petersson
- Faculty of Engineering, Department of Design Sciences, Lund University, Lund, Sweden
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Abstract
Patient portals are access points to patient information, meeting Centers for Medicare and Medicaid Services incentives. Providing patients with access to clinical notes has garnered positive feedback with few concerns. This article addresses the latest literature on patient access to clinical notes and offers suggestions for NPs in their use.
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Affiliation(s)
- Catherine T Fant
- Catherine T. Fant is a professor of nursing graduate programs at Kaplan University, Chicago, Ill. Deborah S. Adelman is an associate professor of nursing at State University of New York at Delhi, Delhi, N.Y
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Gerard M, Fossa A, Folcarelli PH, Walker J, Bell SK. What Patients Value About Reading Visit Notes: A Qualitative Inquiry of Patient Experiences With Their Health Information. J Med Internet Res 2017; 19:e237. [PMID: 28710055 PMCID: PMC5533943 DOI: 10.2196/jmir.7212] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 03/24/2017] [Accepted: 04/19/2017] [Indexed: 01/22/2023] Open
Abstract
Background Patients are increasingly asking for their health data. Yet, little is known about what motivates patients to engage with the electronic health record (EHR). Furthermore, quality-focused mechanisms for patients to comment about their records are lacking. Objective We aimed to learn more about patient experiences with reading and providing feedback on their visit notes. Methods We developed a patient feedback tool linked to OpenNotes as part of a pilot quality improvement initiative focused on patient engagement. Patients who had appointments with members of 2 primary care teams piloting the program between August 2014-2015 were eligible to participate. We asked patients what they liked about reading notes and about using a feedback tool and analyzed all patient reports submitted during the pilot period. Two researchers coded the qualitative responses (κ=.74). Results Patients and care partners submitted 260 reports. Among these, 98.5% (256/260) of reports indicated that the reporting tool was valuable, and 68.8% (179/260) highlighted what patients liked about reading notes and the OpenNotes patient reporting tool process. We identified 4 themes describing what patients value about note content: confirm and remember next steps, quicker access and results, positive emotions, and sharing information with care partners; and 4 themes about both patients’ use of notes and the feedback tool: accuracy and correcting mistakes, partnership and engagement, bidirectional communication and enhanced education, and importance of feedback. Conclusions Patients and care partners who read notes and submitted feedback reported greater engagement and the desire to help clinicians improve note accuracy. Aspects of what patients like about using both notes as well as a feedback tool highlight personal, relational, and safety benefits. Future efforts to engage patients through the EHR may be guided by what patients value, offering opportunities to strengthen care partnerships between patients and clinicians.
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Affiliation(s)
- Macda Gerard
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Alan Fossa
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Patricia H Folcarelli
- Department of Health Care Quality, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Jan Walker
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Sigall K Bell
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
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Bell SK, Mejilla R, Anselmo M, Darer JD, Elmore JG, Leveille S, Ngo L, Ralston JD, Delbanco T, Walker J. When doctors share visit notes with patients: a study of patient and doctor perceptions of documentation errors, safety opportunities and the patient-doctor relationship. BMJ Qual Saf 2017; 26:262-270. [PMID: 27193032 PMCID: PMC7255406 DOI: 10.1136/bmjqs-2015-004697] [Citation(s) in RCA: 124] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2015] [Revised: 04/12/2016] [Accepted: 04/22/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Patient advocates and safety experts encourage adoption of transparent health records, but sceptics worry that shared notes may offend patients, erode trust or promote defensive medicine. As electronic health records disseminate, such disparate views fuel policy debates about risks and benefits of sharing visit notes with patients through portals. METHODS Presurveys and postsurveys from 99 volunteer doctors at three US sites who participated in OpenNotes and postsurveys from 4592 patients who read at least one note and submitted a survey. RESULTS Patients read notes to be better informed and because they were curious; about a third read them to check accuracy. In total, 7% (331) of patients reported contacting their doctor's office about their note. Of these, 29% perceived an error, and 85% were satisfied with its resolution. Nearly all patients reported feeling better (37%) or the same (62%) about their doctor. Patients who were older (>63), male, non-white, had fair/poor self-reported health or had less formal education were more likely to report feeling better about their doctor. Among doctors, 26% anticipated documentation errors, and 44% thought patients would disagree with notes. After a year, 53% believed patient satisfaction increased, and 51% thought patients trusted them more. None reported ordering more tests or referrals. CONCLUSIONS Despite concerns about errors, offending language or defensive practice, transparent notes overall did not harm the patient-doctor relationship. Rather, doctors and patients perceived relational benefits. Traditionally more vulnerable populations-non-white, those with poorer self-reported health and those with fewer years of formal education-may be particularly likely to feel better about their doctor after reading their notes. Further informing debate about OpenNotes, the findings suggest transparent records may improve patient satisfaction, trust and safety.
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Affiliation(s)
- Sigall K Bell
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Roanne Mejilla
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Melissa Anselmo
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Joann G Elmore
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Suzanne Leveille
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
- College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, Massachusetts, USA
| | - Long Ngo
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - James D Ralston
- Group Health Research Institute, Group Health Cooperative, Seattle, Washington, USA
| | - Tom Delbanco
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Jan Walker
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Yu MM, Weathers AL, Wu AD, Evans DA. Sharing notes with patients: A review of current practice and considerations for neurologists. Neurol Clin Pract 2017; 7:179-185. [PMID: 29185532 DOI: 10.1212/cpj.0000000000000335] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 10/26/2016] [Indexed: 11/15/2022]
Abstract
Improved patient engagement is a critical consideration in the new payment climate. Releasing progress notes for patients to view may improve patient involvement and engagement in their care. Patients perceive benefit from viewing physician progress notes. As initial studies involved only primary care physicians, specialist physicians may have specific considerations when releasing notes to patients. This article provides a framework for neurologists to implement a note release policy in their practice.
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Affiliation(s)
- Melissa M Yu
- Department of Neurology (MMY), Baylor College of Medicine, Houston, TX; Department of Neurological Sciences (ALW), Rush University Medical Center, Chicago, IL; Department of Neurology (ADW), David Geffen School of Medicine, University of California Los Angeles; (DAE) Texas Neurology, Dallas
| | - Allison L Weathers
- Department of Neurology (MMY), Baylor College of Medicine, Houston, TX; Department of Neurological Sciences (ALW), Rush University Medical Center, Chicago, IL; Department of Neurology (ADW), David Geffen School of Medicine, University of California Los Angeles; (DAE) Texas Neurology, Dallas
| | - Allan D Wu
- Department of Neurology (MMY), Baylor College of Medicine, Houston, TX; Department of Neurological Sciences (ALW), Rush University Medical Center, Chicago, IL; Department of Neurology (ADW), David Geffen School of Medicine, University of California Los Angeles; (DAE) Texas Neurology, Dallas
| | - David A Evans
- Department of Neurology (MMY), Baylor College of Medicine, Houston, TX; Department of Neurological Sciences (ALW), Rush University Medical Center, Chicago, IL; Department of Neurology (ADW), David Geffen School of Medicine, University of California Los Angeles; (DAE) Texas Neurology, Dallas
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Transformational Impact of Health Information Technology on the Clinical Practice of Child and Adolescent Psychiatry. Child Adolesc Psychiatr Clin N Am 2017; 26:55-66. [PMID: 27837942 DOI: 10.1016/j.chc.2016.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Compared with other medical specialties, psychiatrists have been slower adopters of health information technology (IT) practices, such as electronic health records (EHRs). This delay in implementation could compromise patient safety and impede integration into accountable care organizations and multidisciplinary treatment settings. This article focuses on optimizing use of EHRs for clinical practice, leveraging health IT to improve quality of care, and focusing on the potential for future growth in health IT in child and adolescent psychiatric practice. Aligning with other medical fields and focusing on transparency of mental health treatment will help psychiatrists reach parity with other medical specialties.
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Klein JW, Jackson SL, Bell SK, Anselmo MK, Walker J, Delbanco T, Elmore JG. Your Patient Is Now Reading Your Note: Opportunities, Problems, and Prospects. Am J Med 2016; 129:1018-21. [PMID: 27288854 PMCID: PMC7098183 DOI: 10.1016/j.amjmed.2016.05.015] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 05/20/2016] [Accepted: 05/20/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Jared W Klein
- Department of Medicine, Harborview Medical Center, University of Washington School of Medicine, Seattle.
| | - Sara L Jackson
- Department of Medicine, Harborview Medical Center, University of Washington School of Medicine, Seattle
| | - Sigall K Bell
- Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Melissa K Anselmo
- Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Jan Walker
- Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Tom Delbanco
- Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Joann G Elmore
- Department of Medicine, Harborview Medical Center, University of Washington School of Medicine, Seattle
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Turvey CL, Roberts LJ. Recent developments in the use of online resources and mobile technologies to support mental health care. Int Rev Psychiatry 2016; 27:547-57. [PMID: 26523397 DOI: 10.3109/09540261.2015.1087975] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This review describes recent developments in online and mobile mental health applications, including a discussion of patient portals to support mental health care. These technologies are rapidly evolving, often before there is systematic investigation of their effectiveness. Though there are some reviews of the effectiveness of mental health mobile apps, perhaps the more significant development is innovation in technology evaluation as well as new models of interprofessional collaboration in developing behavioural health technologies. Online mental health programs have a strong evidence base. Their role in population health strategies needs further exploration, including the most effective use of limited clinical staff resources. Patient portals and personal health records serve to enhance mental health treatment also, though concerns specific to mental health must be addressed to support broader adoption of portals. Provider concerns about sharing psychiatric notes with patients hinder support for portals. Health information exchange for mental health information requires thoughtful consent management strategies so mental health patients can benefit. Finally, the broad array of health information technologies may overwhelm patients. User-friendly, well-designed, patient-centred health information technology homes may integrate these functions to promote a holistic approach to care plans and overall wellness. Such technology homes have special security needs and require providers and patients to be well informed about how best to use these technologies to support behavioural health interventions.
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Affiliation(s)
- Carolyn L Turvey
- a Department of Psychiatry, Carver College of Medicine , University of Iowa , Iowa City , Iowa
| | - Lisa J Roberts
- a Department of Psychiatry, Carver College of Medicine , University of Iowa , Iowa City , Iowa.,b AMC Health , New York , USA
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Lee BS, Walker J, Delbanco T, Elmore JG. Transparent Electronic Health Records and Lagging Laws. Ann Intern Med 2016; 165:219-20. [PMID: 27214266 PMCID: PMC7061764 DOI: 10.7326/m15-2827] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Esch T, Mejilla R, Anselmo M, Podtschaske B, Delbanco T, Walker J. Engaging patients through open notes: an evaluation using mixed methods. BMJ Open 2016; 6:e010034. [PMID: 26826154 PMCID: PMC4735137 DOI: 10.1136/bmjopen-2015-010034] [Citation(s) in RCA: 100] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES (A) To gain insights into the experiences of patients invited to view their doctors' visit notes, with a focus on those who review multiple notes; (B) to examine the relationships among fully transparent electronic medical records and quality of care, the patient-doctor relationship, patient engagement, self-care, self-management skills and clinical outcomes. DESIGN Mixed methods qualitative study: analyses of survey data, including content analysis of free-text answers, and quantitative-descriptive measures combined with semistructured individual interviews, patient activation measures, and member checks. SETTING Greater Boston, USA. PARTICIPANTS Patients cared for by primary care physicians (PCPs) at the Beth Israel Deaconess Medical Center who had electronic access to their PCP visit notes. Among those submitting surveys, 576 free-text answers were identified and analysed (414 from female patients, 162 from male patients; 23-88 years). In addition, 13 patients (9 female, 4 male; 58-87 years) were interviewed. RESULTS Patient experiences indicate improved understanding (of health information), better relationships (with doctors), better quality (adherence and compliance; keeping track) and improved self-care (patient-centredness, empowerment). Patients want more doctors to offer access to their notes, and some wish to contribute to their generation. Those patients with repeated experience reviewing notes express fewer concerns and more perceived benefits. CONCLUSIONS As the use of fully transparent medical records spreads, it is important to gain a deeper understanding of possible benefits or harms, and to characterise target populations that may require varying modes of delivery. Patient desires for expansion of this practice extend to specialty care and settings beyond the physician's office. Patients are also interested in becoming involved actively in the generation of their medical records. The OpenNotes movement may increase patient activation and engagement in important ways.
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Affiliation(s)
- Tobias Esch
- Division of General Medicine and Primary Care, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
- Division of Integrative Health Promotion, Coburg University of Applied Sciences, Coburg, Germany
| | - Roanne Mejilla
- Division of General Medicine and Primary Care, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Melissa Anselmo
- Division of General Medicine and Primary Care, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Beatrice Podtschaske
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts, USA
| | - Tom Delbanco
- Division of General Medicine and Primary Care, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jan Walker
- Division of General Medicine and Primary Care, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Connecting Patients and Clinicians: The Anticipated Effects of Open Notes on Patient Safety and Quality of Care. Jt Comm J Qual Patient Saf 2015. [PMID: 26215527 DOI: 10.1016/s1553-7250(15)41049-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Ethical Quandaries for Psychologists in Workers’ Compensation Settings: the GAF Gaffe. PSYCHOLOGICAL INJURY & LAW 2015. [DOI: 10.1007/s12207-015-9218-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Nazi KM, Turvey CL, Klein DM, Hogan TP, Woods SS. VA OpenNotes: exploring the experiences of early patient adopters with access to clinical notes. J Am Med Inform Assoc 2014; 22:380-9. [PMID: 25352570 DOI: 10.1136/amiajnl-2014-003144] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To explore the experience of early patient adopters who accessed their clinical notes online using the Blue Button feature of the My HealtheVet portal. METHODS A web-based survey of VA patient portal users from June 22 to September 15, 2013. RESULTS 33.5% of respondents knew that clinical notes could be viewed, and nearly one in four (23.5%) said that they had viewed their notes at least once. The majority of VA Notes users agreed that accessing their notes will help them to do a better job of taking medications as prescribed (80.1%) and be better prepared for clinic visits (88.6%). Nine out of 10 users agreed that use of visit notes will help them understand their conditions better (91.8%), and better remember the plan for their care (91.9%). In contrast, 87% disagreed that VA Notes will make them worry more, and 88.4% disagreed that access to VA Notes will be more confusing than helpful. Users who had either contacted their provider or healthcare team (11.9%) or planned to (13.5%) primarily wanted to learn more about a health issue, medication, or test results (53.7%). CONCLUSIONS Initial assessment of the patient experience within the first 9 months of availability provides evidence that patients both value and benefit from online access to clinical notes. These findings are congruent with OpenNotes study findings on a broader scale. Additional outreach and education is needed to enhance patient awareness. Healthcare professionals should author notes keeping in mind the opportunity patient access presents for enhanced communication.
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Affiliation(s)
- Kim M Nazi
- Veterans and Consumers Health Informatics Office, Office of Informatics &Analytics, Veterans Health Administration, Department of Veterans Affairs, Washington, DC, USA
| | - Carolyn L Turvey
- Comprehensive Access and Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Iowa City, Iowa, USA Department of Psychiatry, The University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Dawn M Klein
- Comprehensive Access and Delivery Research and Evaluation (CADRE) Center, Iowa City VA Health Care System, Iowa City, Iowa, USA Department of Psychiatry, The University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | - Timothy P Hogan
- Center for Healthcare Organization and Implementation Research (CHOIR), A VA HSR&D Center of Innovation, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Massachusetts, USA National eHealth QUERI Coordinating Center, Edith Nourse Rogers Memorial Veterans Hospital, eHealth Quality Enhancement Research Initiative, Bedford, Massachusetts, USA Division of Health Informatics and Implementation Science, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Susan S Woods
- VA Maine Healthcare System, Togus, Maine, USA Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, Portland, Oregon, USA
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