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van Kessel R, Ranganathan S, Anderson M, McMillan B, Mossialos E. Exploring potential drivers of patient engagement with their health data through digital platforms: A scoping review. Int J Med Inform 2024; 189:105513. [PMID: 38851132 DOI: 10.1016/j.ijmedinf.2024.105513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 04/11/2024] [Accepted: 06/02/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Patient engagement when providing patient access to health data results from an interaction between the available tools and individual capabilities. The recent digital advancements of the healthcare field have altered the manifestation and importance of patient engagement. However, a comprehensive assessment of what factors contribute to patient engagement remain absent. In this review article, we synthesised the most frequently discussed factors that can foster patient engagement with their health data. METHODS A scoping review was conducted in MEDLINE, Embase, and Google Scholar. Relevant data were synthesized within 7 layers using a thematic analysis: (1) social and demographic factors, (2) patient ability factors, (3) patient motivation factors, (4) factors related to healthcare professionals' attitudes and skills, (5) health system factors, (6) technological factors, and (7) policy factors. RESULTS We identified 5801 academic and 200 Gy literature records, and included 292 (4.83%) in this review. Overall, 44 factors that can affect patient engagement with their health data were extracted. We extracted 6 social and demographic factors, 6 patient ability factors, 12 patient motivation factors, 7 factors related to healthcare professionals' attitudes and skills, 4 health system factors, 6 technological factors, and 3 policy factors. CONCLUSIONS Improving patient engagement with their health data enables the development of patient-centered healthcare, though it can also exacerbate existing inequities. While expanding patient access to health data is an important step towards fostering shared decision-making in healthcare and subsequently empowering patients, it is important to ensure that these developments reach all sectors of the community.
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Affiliation(s)
- Robin van Kessel
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom; Department of International Health, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands; Digital Public Health Task Force, Association of School of Public Health in the European Region (ASPHER), Brussels, Belgium.
| | | | - Michael Anderson
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom; Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom.
| | - Brian McMillan
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom.
| | - Elias Mossialos
- LSE Health, Department of Health Policy, London School of Economics and Political Science, London, United Kingdom; Institute of Global Health Innovation, Imperial College London, London, United Kingdom.
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Moll J, Scandurra I, Bärkås A, Blease C, Hägglund M, Hörhammer I, Kane B, Kristiansen E, Ross P, Åhlfeldt RM, Klein GO. Sociotechnical Cross-Country Analysis of Contextual Factors That Impact Patients' Access to Electronic Health Records in 4 European Countries: Framework Evaluation Study. J Med Internet Res 2024; 26:e55752. [PMID: 39186760 DOI: 10.2196/55752] [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: 12/22/2023] [Revised: 04/05/2024] [Accepted: 04/08/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND The NORDeHEALTH project studies patient-accessible electronic health records (PAEHRs) in Estonia, Finland, Norway, and Sweden. Such country comparisons require an analysis of the sociotechnical context of these services. Although sociotechnical analyses of PAEHR services have been carried out in the past, a framework specifically tailored to in-depth cross-country analysis has not been developed. OBJECTIVE This study aims to develop and evaluate a method for a sociotechnical analysis of PAEHRs that advances a framework for sociotechnical analysis of eHealth solutions first presented by Sittig and Singh. This first article in a series presents the development of the method and a cross-country comparison of the contextual factors that enable PAEHR access and use. METHODS The dimensions of the framework for sociotechnical analysis were thoroughly discussed and extended in a series of workshops with international stakeholders, all being eHealth researchers focusing on PAEHRs. All countries were represented in the working group to make sure that important national perspectives were covered. A spreadsheet with relevant questions related to the studied services and the various dimensions of the sociotechnical framework was constructed and distributed to the 4 participating countries, and the project participants researched various national sources to provide the relevant data for the comparisons in the 10 sociotechnical dimensions. RESULTS In total, 3 dimensions were added to the methodology of Sittig and Singh to separate clinical content from features and functions of PAEHRs and demonstrate basic characteristics of the different countries regarding national and regional steering of health care and information and communications technology developments. The final framework contained the following dimensions: metadata; hardware and software computing infrastructure; features and functions; clinical content shared with patients; human-computer interface; people; workflow and communication; the health care organization's internal policies, procedures, and culture; national rules, regulations, and incentives; system measurement and monitoring; and health care system context. The dimensions added during the study mostly concerned background information needed for cross-country comparisons in particular. Several similarities were identified among the compared countries, especially regarding hardware and software computing infrastructure. All countries had, for example, one national access point, and patients are provided a PAEHR automatically. Most of the differences could be identified in the health care system context dimension. One important difference concerned the governing of information and communications technology development, where different levels (state, region, and municipality) were responsible in different countries. CONCLUSIONS This is the first large-scale international sociotechnical analysis of services for patients to access their electronic health records; this study compared services in Estonia, Finland, Norway, and Sweden. A methodology for such an analysis was developed and is presented to enable comparison studies in other national contexts to enable future implementations and evaluations of PAEHRs.
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Affiliation(s)
- Jonas Moll
- Centre for Empirical Research on Information systems, School of Business, Örebro University, Örebro, Sweden
| | - Isabella Scandurra
- Centre for Empirical Research on Information systems, School of Business, Örebro University, Örebro, Sweden
| | - Annika Bärkås
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Medtech Science & Innovation Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Charlotte Blease
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Digital Psychiatry, Department of Psychiatry Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Maria Hägglund
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Medtech Science & Innovation Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Iiris Hörhammer
- Department of Computer Science, Aalto University, Espoo, Finland
| | - Bridget Kane
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Karlstad University Business School, Karlstad, Sweden
| | - Eli Kristiansen
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Peeter Ross
- E-Medicine Centre, Department of Health Technologies, Tallinn University of Technology, Tallinn, Estonia
- Research Department, East Tallinn Central Hospital, Tallinn, Estonia
| | | | - Gunnar O Klein
- Centre for Empirical Research on Information systems, School of Business, Örebro University, Örebro, Sweden
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Hunt J, Blease C. Epistemic injustice, healthcare disparities and the missing pipeline: reflections on the exclusion of disabled scholars from health research. JOURNAL OF MEDICAL ETHICS 2024:jme-2023-109837. [PMID: 38782548 DOI: 10.1136/jme-2023-109837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Accepted: 04/13/2024] [Indexed: 05/25/2024]
Abstract
People with disabilities are subject to multiple forms of health-related and wider social disparities; carefully focused research is required to inform more inclusive, safe and effective healthcare practice and policy. Through lived experience, disabled people are well positioned to identify and persistently pursue problems and opportunities within existing health provisions that may be overlooked by a largely non-disabled research community. Thus, the academy can play an important role in shining a light on the perspectives and insights from within the disability community, and combined with policy decisions, these perspectives and insights have a better opportunity to become integrated into the fabric of public life, within healthcare and beyond. However, despite the potential benefits that could be yielded by greater inclusivity, in this paper we describe barriers within the UK academy confronting disabled people who wish to embark on health research. We do this by drawing on published findings, and via the lived experience of the first author, who has struggled for over 3 years to find an accessible PhD programme as a person with energy limiting conditions who is largely confined to the home in the UK. First, we situate the discussion in the wider perspective of epistemic injustice in health research. Second, we consider evidence of epistemic injustice among disabled researchers, focusing primarily on what philosophers Kidd and Carel (2017, p 184) describe as 'strategies of exclusion'. Third, we offer recommendations for overcoming these barriers to improve the pipeline of researchers with disabilities in the academy.
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Affiliation(s)
- Joanne Hunt
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Charlotte Blease
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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Fagerlund AJ, Bärkås A, Kharko A, Blease CR, Hagström J, Huvila I, Hörhammer I, Kane B, Kristiansen E, Kujala S, Moll J, Rexhepi H, Scandurra I, Simola S, Soone H, Wang B, Åhlfeldt RM, Hägglund M, Johansen MA. Experiences from patients in mental healthcare accessing their electronic health records: results from a cross-national survey in Estonia, Finland, Norway, and Sweden. BMC Psychiatry 2024; 24:481. [PMID: 38956493 PMCID: PMC11220963 DOI: 10.1186/s12888-024-05916-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 06/17/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Patients' online record access (ORA) enables patients to read and use their health data through online digital solutions. One such solution, patient-accessible electronic health records (PAEHRs) have been implemented in Estonia, Finland, Norway, and Sweden. While accumulated research has pointed to many potential benefits of ORA, its application in mental healthcare (MHC) continues to be contested. The present study aimed to describe MHC users' overall experiences with national PAEHR services. METHODS The study analysed the MHC-part of the NORDeHEALTH 2022 Patient Survey, a large-scale multi-country survey. The survey consisted of 45 questions, including demographic variables and questions related to users' experiences with ORA. We focused on the questions concerning positive experiences (benefits), negative experiences (errors, omissions, offence), and breaches of security and privacy. Participants were included in this analysis if they reported receiving mental healthcare within the past two years. Descriptive statistics were used to summarise data, and percentages were calculated on available data. RESULTS 6,157 respondents were included. In line with previous research, almost half (45%) reported very positive experiences with ORA. A majority in each country also reported improved trust (at least 69%) and communication (at least 71%) with healthcare providers. One-third (29.5%) reported very negative experiences with ORA. In total, half of the respondents (47.9%) found errors and a third (35.5%) found omissions in their medical documentation. One-third (34.8%) of all respondents also reported being offended by the content. When errors or omissions were identified, about half (46.5%) reported that they took no action. There seems to be differences in how patients experience errors, omissions, and missing information between the countries. A small proportion reported instances where family or others demanded access to their records (3.1%), and about one in ten (10.7%) noted that unauthorised individuals had seen their health information. CONCLUSIONS Overall, MHC patients reported more positive experiences than negative, but a large portion of respondents reported problems with the content of the PAEHR. Further research on best practice in implementation of ORA in MHC is therefore needed, to ensure that all patients may reap the benefits while limiting potential negative consequences.
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Affiliation(s)
- A J Fagerlund
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - Annika Bärkås
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
- MedTech Science & Innovation Centre, Uppsala University Hospital, Dag Hammarskjölds väg 14b, 1 floor, Uppsala, 75185, Sweden.
| | - A Kharko
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- MedTech Science & Innovation Centre, Uppsala University Hospital, Dag Hammarskjölds väg 14b, 1 floor, Uppsala, 75185, Sweden
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - C R Blease
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- MedTech Science & Innovation Centre, Uppsala University Hospital, Dag Hammarskjölds väg 14b, 1 floor, Uppsala, 75185, Sweden
- Digital Psychiatry, Dept of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - J Hagström
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- MedTech Science & Innovation Centre, Uppsala University Hospital, Dag Hammarskjölds väg 14b, 1 floor, Uppsala, 75185, Sweden
| | - I Huvila
- Department of ALM, Uppsala University, Uppsala, Sweden
| | - I Hörhammer
- Department of Computer Science, Aalto University, Espoo, Finland
| | - B Kane
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Business School, Karlstad University, Karlstad, Sweden
- Centre for Health Policy and Management, Trinity College Dublin, Dublin, Ireland
| | - E Kristiansen
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - S Kujala
- Department of Computer Science, Aalto University, Espoo, Finland
| | - J Moll
- Centre for Empirical Research on Information systems, School of Business, Örebro University, Örebro, Sweden
| | - H Rexhepi
- School of Informatics, University of Skövde, Skövde, Sweden
| | - I Scandurra
- Centre for Empirical Research on Information systems, School of Business, Örebro University, Örebro, Sweden
| | - S Simola
- Department of Computer Science, Aalto University, Espoo, Finland
| | - H Soone
- E-Medicine Centre, Department of Health Technologies, Tallinn University of Technology, Tallinn, Estonia
| | - B Wang
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | - R M Åhlfeldt
- School of Informatics, University of Skövde, Skövde, Sweden
| | - M Hägglund
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- MedTech Science & Innovation Centre, Uppsala University Hospital, Dag Hammarskjölds väg 14b, 1 floor, Uppsala, 75185, Sweden
| | - M A Johansen
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
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Hägglund M, Kharko A, Bärkås A, Blease C, Cajander Å, DesRoches C, Fagerlund AJ, Hagström J, Huvila I, Hörhammer I, Kane B, Klein GO, Kristiansen E, Moll J, Muli I, Rexhepi H, Riggare S, Ross P, Scandurra I, Simola S, Soone H, Wang B, Ghorbanian Zolbin M, Åhlfeldt RM, Kujala S, Johansen MA. A Nordic Perspective on Patient Online Record Access and the European Health Data Space. J Med Internet Res 2024; 26:e49084. [PMID: 38935430 PMCID: PMC11240068 DOI: 10.2196/49084] [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: 05/17/2023] [Revised: 10/31/2023] [Accepted: 04/25/2024] [Indexed: 06/28/2024] Open
Abstract
The Nordic countries are, together with the United States, forerunners in online record access (ORA), which has now become widespread. The importance of accessible and structured health data has also been highlighted by policy makers internationally. To ensure the full realization of ORA's potential in the short and long term, there is a pressing need to study ORA from a cross-disciplinary, clinical, humanistic, and social sciences perspective that looks beyond strictly technical aspects. In this viewpoint paper, we explore the policy changes in the European Health Data Space (EHDS) proposal to advance ORA across the European Union, informed by our research in a Nordic-led project that carries out the first of its kind, large-scale international investigation of patients' ORA-NORDeHEALTH (Nordic eHealth for Patients: Benchmarking and Developing for the Future). We argue that the EHDS proposal will pave the way for patients to access and control third-party access to their electronic health records. In our analysis of the proposal, we have identified five key principles for ORA: (1) the right to access, (2) proxy access, (3) patient input of their own data, (4) error and omission rectification, and (5) access control. ORA implementation today is fragmented throughout Europe, and the EHDS proposal aims to ensure all European citizens have equal online access to their health data. However, we argue that in order to implement the EHDS, we need more research evidence on the key ORA principles we have identified in our analysis. Results from the NORDeHEALTH project provide some of that evidence, but we have also identified important knowledge gaps that still need further exploration.
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Affiliation(s)
- Maria Hägglund
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Medtech Science & Innovation Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Anna Kharko
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- School of Psychology, Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Annika Bärkås
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Charlotte Blease
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Åsa Cajander
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | - Catherine DesRoches
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | | | - Josefin Hagström
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Isto Huvila
- Department of ALM, Uppsala University, Uppsala, Sweden
| | - Iiris Hörhammer
- Department of Computer Science, Aalto University, Espoo, Finland
| | - Bridget Kane
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Business School, Karlstad University, Karlstad, Sweden
| | - Gunnar O Klein
- Centre for Empirical Research on Information Systems, School of Business, Örebro University, Örebro, Sweden
| | - Eli Kristiansen
- Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway
| | - Jonas Moll
- Centre for Empirical Research on Information Systems, School of Business, Örebro University, Örebro, Sweden
| | - Irene Muli
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Hanife Rexhepi
- School of Informatics, University of Skövde, Skövde, Sweden
| | - Sara Riggare
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Peeter Ross
- E-Medicine Centre, Department of Health Technologies, Tallinn University of Technology, Tallinn, Estonia
- Research Department, East Tallinn Central Hospital, Tallinn, Estonia
| | - Isabella Scandurra
- Centre for Empirical Research on Information Systems, School of Business, Örebro University, Örebro, Sweden
| | - Saija Simola
- Department of Computer Science, Aalto University, Espoo, Finland
| | - Hedvig Soone
- E-Medicine Centre, Department of Health Technologies, Tallinn University of Technology, Tallinn, Estonia
| | - Bo Wang
- Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway
| | | | | | - Sari Kujala
- Department of Computer Science, Aalto University, Espoo, Finland
| | - Monika Alise Johansen
- Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway
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Schwarz J, Hoetger C, Pluschke LS, Muehlensiepen F, Schneider M, Thoma S, Esch T. Psychiatrists' perceptions of conditions and consequences associated with the implementation of open notes: qualitative investigation. BMC Psychiatry 2024; 24:430. [PMID: 38858711 PMCID: PMC11163720 DOI: 10.1186/s12888-024-05845-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 05/13/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVE In a growing list of countries, patients are granted access to their clinical notes ("open notes") as part of their online record access. Especially in the field of mental health, open notes remain controversial with some clinicians perceiving open notes as a tool for improving therapeutic outcomes by increasing patient involvement, while others fear that patients might experience psychological distress and perceived stigmatization, particularly when reading clinicians' notes. More research is needed to optimize the benefits and mitigate the risks. METHODS Using a qualitative research design, we conducted semi-structured interviews with psychiatrists practicing in Germany, to explore what conditions they believe need to be in place to ensure successful implementation of open notes in psychiatric practice as well as expected subsequent changes to their workload and treatment outcomes. Data were analyzed using thematic analysis. RESULTS We interviewed 18 psychiatrists; interviewees believed four key conditions needed to be in place prior to implementation of open notes including careful consideration of (1) diagnoses and symptom severity, (2) the availability of additional time for writing clinical notes and discussing them with patients, (3) available resources and system compatibility, and (4) legal and data protection aspects. As a result of introducing open notes, interviewees expected changes in documentation, treatment processes, and doctor-physician interaction. While open notes were expected to improve transparency and trust, participants anticipated negative unintended consequences including the risk of deteriorating therapeutic relationships due to note access-related misunderstandings and conflicts. CONCLUSION Psychiatrists practiced in Germany where open notes have not yet been established as part of the healthcare data infrastructure. Interviewees were supportive of open notes but had some reservations. They found open notes to be generally beneficial but anticipated effects to vary depending on patient characteristics. Clear guidelines for managing access, time constraints, usability, and privacy are crucial. Open notes were perceived to increase transparency and patient involvement but were also believed to raise issues of stigmatization and conflicts.
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Affiliation(s)
- Julian Schwarz
- Department of Psychiatry and Psychotherapy, Center for Mental Health, Immanuel Hospital Rüdersdorf, Brandenburg Medical School Theodor Fontane, Seebad 82/83, Rüdersdorf, DE, Germany.
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany.
| | - Cosima Hoetger
- Institute for Integrative Health Care and Health Promotion (IGVF), Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Lena-Sophie Pluschke
- Department of Psychiatry and Psychotherapy, Center for Mental Health, Immanuel Hospital Rüdersdorf, Brandenburg Medical School Theodor Fontane, Seebad 82/83, Rüdersdorf, DE, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany
| | - Felix Muehlensiepen
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany
- Center for Health Services Research, Brandenburg Medical School, Rüdersdorf, Germany
| | - Michael Schneider
- Department of Psychiatry and Psychotherapy, Center for Mental Health, Immanuel Hospital Rüdersdorf, Brandenburg Medical School Theodor Fontane, Seebad 82/83, Rüdersdorf, DE, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany
| | - Samuel Thoma
- Department of Psychiatry and Psychotherapy, Center for Mental Health, Immanuel Hospital Rüdersdorf, Brandenburg Medical School Theodor Fontane, Seebad 82/83, Rüdersdorf, DE, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School, Neuruppin, Germany
| | - Tobias Esch
- Institute for Integrative Health Care and Health Promotion (IGVF), Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
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Lam K, Leung CH, Soomro Z, Wathoo C, Weathers SP. Perspectives from neuro-oncology providers on patient access to electronic records: a survey study. CNS Oncol 2024; 13:2352414. [PMID: 38869443 PMCID: PMC11152585 DOI: 10.1080/20450907.2024.2352414] [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: 01/17/2024] [Accepted: 04/30/2024] [Indexed: 06/14/2024] Open
Abstract
Aim: To evaluate the neuro-oncology providers' experience with patient online access to electronic records. Methods: Cross-sectional survey for physicians and advanced care providers within the field of neuro-oncology in the USA. Results: 65 providers completed the survey, from all major regions of the USA. 58% reported that at least once per month, patients contacted them outside of an office visit about provider notes or a laboratory or imaging finding accessed online. 54% of providers did not think that all laboratory results should be released automatically, and only 25% of providers thought that all radiology reads should be released immediately. 97% thought that some patients suffered substantial distress viewing test results prior to appointments. Qualitative responses aligned with the quantitative results. Conclusion: Most neuro-oncology providers are concerned about the immediate release of laboratory and imaging findings to patients without guidance.
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Affiliation(s)
- Keng Lam
- Department of Neuro-Oncology, Unit 431, The University of Texas MD Anderson Cancer, 1400 Holcombe Blvd, Room FC7.3000, Houston, TX77030, USA
| | - Cheuk Hong Leung
- Department of Biostatistics, The University of Texas MD Anderson Cancer, 1400 Pressler St, Houston, TX77030, USA
| | - Zaid Soomro
- Department of Neuro-Oncology, Unit 431, The University of Texas MD Anderson Cancer, 1400 Holcombe Blvd, Room FC7.3000, Houston, TX77030, USA
| | - Chetna Wathoo
- Department of Neuro-Oncology, Unit 431, The University of Texas MD Anderson Cancer, 1400 Holcombe Blvd, Room FC7.3000, Houston, TX77030, USA
| | - Shiao-Pei Weathers
- Department of Neuro-Oncology, Unit 431, The University of Texas MD Anderson Cancer, 1400 Holcombe Blvd, Room FC7.3000, Houston, TX77030, USA
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Bell SK, Amat MJ, Anderson TS, Aronson MD, Benneyan JC, Fernandez L, Ricci DA, Salant T, Schiff GD, Shafiq U, Singer SJ, Sternberg SB, Zhang C, Phillips RS. Do patients who read visit notes on the patient portal have a higher rate of "loop closure" on diagnostic tests and referrals in primary care? A retrospective cohort study. J Am Med Inform Assoc 2024; 31:622-630. [PMID: 38164964 PMCID: PMC10873783 DOI: 10.1093/jamia/ocad250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 11/21/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVES The 2021 US Cures Act may engage patients to help reduce diagnostic errors/delays. We examined the relationship between patient portal registration with/without note reading and test/referral completion in primary care. MATERIALS AND METHODS Retrospective cohort study of patients with visits from January 1, 2018 to December 31, 2021, and order for (1) colonoscopy, (2) dermatology referral for concerning lesions, or (3) cardiac stress test at 2 academic primary care clinics. We examined differences in timely completion ("loop closure") of tests/referrals for (1) patients who used the portal and read ≥1 note (Portal + Notes); (2) those with a portal account but who did not read notes (Portal Account Only); and (3) those who did not register for the portal (No Portal). We estimated the predictive probability of loop closure in each group after adjusting for socio-demographic and clinical factors using multivariable logistic regression. RESULTS Among 12 849 tests/referrals, loop closure was more common among Portal+Note-readers compared to their counterparts for all tests/referrals (54.2% No Portal, 57.4% Portal Account Only, 61.6% Portal+Notes, P < .001). In adjusted analysis, compared to the No Portal group, the odds of loop closure were significantly higher for Portal Account Only (OR 1.2; 95% CI, 1.1-1.4), and Portal+Notes (OR 1.4; 95% CI, 1.3-1.6) groups. Beyond portal registration, note reading was independently associated with loop closure (P = .002). DISCUSSION AND CONCLUSION Compared to no portal registration, the odds of loop closure were 20% higher in tests/referrals for patients with a portal account, and 40% higher in tests/referrals for note readers, after controlling for sociodemographic and clinical factors. However, important safety gaps from unclosed loops remain, requiring additional engagement strategies.
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Affiliation(s)
- Sigall K Bell
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Maelys J Amat
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Timothy S Anderson
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Mark D Aronson
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - James C Benneyan
- Healthcare Systems Engineering Institute, Northeastern University, Boston, MA 02115, United States
| | - Leonor Fernandez
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Dru A Ricci
- Center for Primary Care, Harvard Medical School, Boston, MA 02115, United States
| | - Talya Salant
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
- Bowdoin Street Health Center, Dorchester, MA 02122, United States
| | - Gordon D Schiff
- Center for Primary Care, Harvard Medical School, Boston, MA 02115, United States
- Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, United States
| | - Umber Shafiq
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Sara J Singer
- Department of Health Policy, Stanford University School of Medicine, Stanford, CA 94305, United States
| | - Scot B Sternberg
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Cancan Zhang
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
| | - Russell S Phillips
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, United States
- Center for Primary Care, Harvard Medical School, Boston, MA 02115, United States
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9
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Torous J, Blease C. Return of Results in Digital Phenotyping: Ethical Considerations for Real-World Use Cases. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024; 24:91-93. [PMID: 38295252 DOI: 10.1080/15265161.2024.2298146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Affiliation(s)
- John Torous
- Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Charlotte Blease
- Beth Israel Deaconess Medical Center, Harvard Medical School
- Uppsala University
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Blease CR, Kharko A, Dong Z, Jones RB, Davidge G, Hagglund M, Turner A, DesRoches C, McMillan B. Experiences and opinions of general practitioners with patient online record access: an online survey in England. BMJ Open 2024; 14:e078158. [PMID: 38302414 PMCID: PMC10806584 DOI: 10.1136/bmjopen-2023-078158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 12/22/2023] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVE To describe the experiences and opinions of general practitioners (GPs) in England regarding patients having access to their full online GP health records. DESIGN Convenience sample, online survey. PARTICIPANTS 400 registered GPs in England. MAIN OUTCOME MEASURES Investigators measured GPs' experiences and opinions about online record access (ORA), including patient care and their practice. RESULTS A total of 400 GPs from all regions of England responded. A minority (130, 33%) believed ORA was a good idea. Most GPs believed a majority of patients would worry more (364, 91%) or find their GP records more confusing than helpful (338, 85%). Most GPs believed a majority of patients would find significant errors in their records (240, 60%), would better remember their care plan (280, 70%) and feel more in control of their care (243, 60%). The majority believed they will/already spend more time addressing patients' questions outside of consultations (357, 89%), that consultations will/already take significantly longer (322, 81%) and that they will be/already are less candid in their documentation (289, 72%) after ORA. Nearly two-thirds of GPs believed ORA would increase their litigation (246, 62%). CONCLUSIONS Similar to clinicians in other countries, GPs in our sample were sceptical of ORA, believing patients would worry more and find their records more confusing than helpful. Most GPs also believed the practice would exacerbate work burdens. However, the majority of GPs in this survey also agreed there were multiple benefits to patients having online access to their primary care health records. The findings of this survey also contribute to a growing body of contrastive research from countries where ORA is advanced, demonstrating clinicians are sceptical while studies indicate patients appear to derive multiple benefits.
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Affiliation(s)
- Charlotte R Blease
- Uppsala Universitet, Uppsala, Sweden
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Anna Kharko
- Faculty of Health, University of Plymouth, Plymouth, UK
- Department of Women and Children's Health, Uppsala Universitet, Uppsala, Sweden
| | - Zhiyong Dong
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Ray B Jones
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Gail Davidge
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Maria Hagglund
- Department of Women and Children's Health, Uppsala Universitet, Uppsala, Sweden
- Medtech Science & Innovation Centre, Uppsala University Hospital, Uppsala, Sweden
| | | | - Catherine DesRoches
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Brian McMillan
- Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
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11
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Blease C. Open AI meets open notes: surveillance capitalism, patient privacy and online record access. JOURNAL OF MEDICAL ETHICS 2024; 50:84-89. [PMID: 38050159 PMCID: PMC10850625 DOI: 10.1136/jme-2023-109574] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 10/30/2023] [Indexed: 12/06/2023]
Abstract
Patient online record access (ORA) is spreading worldwide, and in some countries, including Sweden, and the USA, access is advanced with patients obtaining rapid access to their full records. In the UK context, from 31 October 2023 as part of the new NHS England general practitioner (GP) contract it will be mandatory for GPs to offer ORA to patients aged 16 and older. Patients report many benefits from reading their clinical records including feeling more empowered, better understanding and remembering their treatment plan, and greater awareness about medications including possible adverse effects. However, a variety of indirect evidence suggests these benefits are unlikely to accrue without supplementation from internet-based resources. Using such routes to augment interpretation of the data and notes housed in electronic health records, however, comes with trade-offs in terms of exposing sensitive patient information to internet corporations. Furthermore, increased work burdens on clinicians, including the unique demands of ORA, combined with the easy availability and capability of a new generation of large language model (LLM)-powered chatbots, create a perfect collision course for exposing sensitive patient information to private tech companies. This paper surveys how ORA intersects with internet associated privacy risks and offers a variety of multilevel suggestions for how these risks might be better mitigated.
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Affiliation(s)
- Charlotte Blease
- Women's and Children's Health, Uppsala Universitet, Uppsala, Sweden
- Digital Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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12
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Blease C, Torous J, McMillan B, Hägglund M, Mandl KD. Generative Language Models and Open Notes: Exploring the Promise and Limitations. JMIR MEDICAL EDUCATION 2024; 10:e51183. [PMID: 38175688 PMCID: PMC10797501 DOI: 10.2196/51183] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 09/30/2023] [Accepted: 11/10/2023] [Indexed: 01/05/2024]
Abstract
Patients' online record access (ORA) is growing worldwide. In some countries, including the United States and Sweden, access is advanced with patients obtaining rapid access to their full records on the web including laboratory and test results, lists of prescribed medications, vaccinations, and even the very narrative reports written by clinicians (the latter, commonly referred to as "open notes"). In the United States, patient's ORA is also available in a downloadable form for use with other apps. While survey studies have shown that some patients report many benefits from ORA, there remain challenges with implementation around writing clinical documentation that patients may now read. With ORA, the functionality of the record is evolving; it is no longer only an aide memoire for doctors but also a communication tool for patients. Studies suggest that clinicians are changing how they write documentation, inviting worries about accuracy and completeness. Other concerns include work burdens; while few objective studies have examined the impact of ORA on workload, some research suggests that clinicians are spending more time writing notes and answering queries related to patients' records. Aimed at addressing some of these concerns, clinician and patient education strategies have been proposed. In this viewpoint paper, we explore these approaches and suggest another longer-term strategy: the use of generative artificial intelligence (AI) to support clinicians in documenting narrative summaries that patients will find easier to understand. Applied to narrative clinical documentation, we suggest that such approaches may significantly help preserve the accuracy of notes, strengthen writing clarity and signals of empathy and patient-centered care, and serve as a buffer against documentation work burdens. However, we also consider the current risks associated with existing generative AI. We emphasize that for this innovation to play a key role in ORA, the cocreation of clinical notes will be imperative. We also caution that clinicians will need to be supported in how to work alongside generative AI to optimize its considerable potential.
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Affiliation(s)
- Charlotte Blease
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - John Torous
- Digital Psychiatry, Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Brian McMillan
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom
| | - Maria Hägglund
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Medtech Science & Innovation Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Kenneth D Mandl
- Computational Health Informatics Program, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States
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13
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Kharko A, Buergler S, Bärkås A, Hägglund M, Gaab J, Fagerlund AJ, Locher C, Blease C. Open notes in psychotherapy: An exploratory mixed methods survey of psychotherapy students in Switzerland. Digit Health 2024; 10:20552076241242772. [PMID: 38559581 PMCID: PMC10981219 DOI: 10.1177/20552076241242772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 03/12/2024] [Indexed: 04/04/2024] Open
Abstract
Background In a growing number of countries, patients are offered access to their full online clinical records, including the narrative reports written by clinicians (the latter, referred to as "open notes"). Even in countries with mature patient online record access, access to psychotherapy notes is not mandatory. To date, no research has explored the views of psychotherapy trainees about open notes. Objective This study aimed to explore the opinions of psychotherapy trainees in Switzerland about patients' access to psychotherapists' free-text summaries. Methods We administered a web-based mixed methods survey to 201 psychotherapy trainees to explore their familiarity with and opinions about the impact on patients and psychotherapy practice of offering patients online access to their psychotherapy notes. Descriptive statistics were used to analyze the 42-item survey, and qualitative descriptive analysis was employed to examine written responses to four open-ended questions. Results Seventy-two (35.8%) trainees completed the survey. Quantitative results revealed mixed views about open notes. 75% agreed that, in general open notes were a good idea, and 94.1% agreed that education about open notes should be part of psychotherapy training. When considering impact on patients and psychotherapy, four themes emerged: (a) negative impact on therapy; (b) positive impact on therapy; (c) impact on patients; and (d) documentation. Students identified concerns related to increase in workload, harm to the psychotherapeutic relationship, and compromised quality of records. They also identified many potential benefits including better patient communication and informed consent processes. In describing impact on different therapy types, students believed that open notes might have differential impact depending on the psychotherapy approaches. Conclusions Sharing psychotherapy notes is not routine but is likely to expand. This mixed methods study provides timely insights into the views of psychotherapy trainees regarding the impact of open notes on patient care and psychotherapy practice.
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Affiliation(s)
- Anna Kharko
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Sarah Buergler
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Annika Bärkås
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Maria Hägglund
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | | | - Cosima Locher
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, University of Zurich, Basel, Switzerland
| | - Charlotte Blease
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Uppsala, Sweden
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14
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Stead WW, Miller RA, Ohno-Machado L, Bakken S. JAMIA at 30: looking back and forward. J Am Med Inform Assoc 2023; 31:1-9. [PMID: 38134400 PMCID: PMC10746314 DOI: 10.1093/jamia/ocad215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 12/24/2023] Open
Affiliation(s)
- William W Stead
- Department of Biomedical Informatics, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN 37232, United States
| | - Randolph A Miller
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Alexandria, VA 37232, United States
| | - Lucila Ohno-Machado
- Section of Biomedical Informatics & Data Science, Yale University School of Medicine, New Haven, CT 06520, United States
| | - Suzanne Bakken
- School of Nursing, Department of Biomedical Informatics, Data Science Institute, Columbia University, New York, NY 10032, United States
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15
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Bärkås A, Kharko A, Blease C, Cajander Å, Johansen Fagerlund A, Huvila I, Johansen MA, Kane B, Kujala S, Moll J, Rexhepi H, Scandurra I, Wang B, Hägglund M. Errors, Omissions, and Offenses in the Health Record of Mental Health Care Patients: Results from a Nationwide Survey in Sweden. J Med Internet Res 2023; 25:e47841. [PMID: 37921861 PMCID: PMC10656659 DOI: 10.2196/47841] [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: 04/03/2023] [Revised: 09/06/2023] [Accepted: 09/28/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Previous research reports that patients with mental health conditions experience benefits, for example, increased empowerment and validation, from reading their patient-accessible electronic health records (PAEHRs). In mental health care (MHC), PAEHRs remain controversial, as health care professionals are concerned that patients may feel worried or offended by the content of the notes. Moreover, existing research has focused on specific mental health diagnoses, excluding the larger PAEHR userbase with experience in MHC. OBJECTIVE The objective of this study is to establish if and how the experiences of patients with and those without MHC differ in using their PAEHRs by (1) comparing patient characteristics and differences in using the national patient portal between the 2 groups and (2) establishing group differences in the prevalence of negative experiences, for example, rates of errors, omissions, and offenses between the 2 groups. METHODS Our analysis was performed on data from an online patient survey distributed through the Swedish national patient portal as part of our international research project, NORDeHEALTH. The respondents were patient users of the national patient portal 1177, aged 15 years or older, and categorized either as those with MHC experience or with any other health care experience (nonmental health care [non-MHC]). Patient characteristics such as gender, age, education, employment, and health status were gathered. Portal use characteristics included frequency of access, encouragement to read the record, and instances of positive and negative experiences. Negative experiences were further explored through rates of error, omission, and offense. The data were summarized through descriptive statistics. Group differences were analyzed through Pearson chi-square. RESULTS Of the total sample (N=12,334), MHC respondents (n=3131) experienced errors (1586/3131, 50.65%, and non-MHC 3311/9203, 35.98%), omissions (1089/3131, 34.78%, and non-MHC 2427/9203, 26.37%) and offenses (1183/3131, 37.78%, and non-MHC 1616/9203, 17.56%) in the electronic health record at a higher rate than non-MHC respondents (n=9203). Respondents reported that the identified error (MHC 795/3131, 50.13%, and non-MHC 1366/9203, 41.26%) and omission (MHC 622/3131, 57.12%, and non-MHC 1329/9203, 54.76%) were "very important," but most did nothing to correct them (MHC 792/3131, 41.29%, and non-MHC 1838/9203, 42.17%). Most of the respondents identified as women in both groups. CONCLUSIONS About 1 in 2 MHC patients identified an error in the record, and about 1 in 3 identified an omission, both at a much higher rate than in the non-MHC group. Patients with MHC also felt offended by the content of the notes more commonly (1 in 3 vs 1 in 6). These findings validate some of the worries expressed by health care professionals about providing patients with MHC with PAEHRs and highlight challenges with the documentation quality in the records.
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Affiliation(s)
- Annika Bärkås
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- MedTech Science & Innovation Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Anna Kharko
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- MedTech Science & Innovation Centre, Uppsala University Hospital, Uppsala, Sweden
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Charlotte Blease
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- MedTech Science & Innovation Centre, Uppsala University Hospital, Uppsala, Sweden
- Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Åsa Cajander
- Department of Information Technology, Uppsala University, Uppsala, Sweden
| | | | - Isto Huvila
- Department of ALM, Uppsala University, Uppsala, Sweden
| | - Monika Alise Johansen
- Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, Telemedicine and E-health Research Group, Arctic University of Norway, Tromsø, Norway
| | - Bridget Kane
- Business School, Karlstad University, Karlstad, Sweden
| | - Sari Kujala
- Department of Computer Science, Aalto University, Espoo, Finland
| | - Jonas Moll
- Centre for Empirical Research on Information Systems, School of Business, Örebro University, Örebro, Sweden
| | - Hanife Rexhepi
- School of Informatics, University of Skövde, Skövde, Sweden
| | - Isabella Scandurra
- Centre for Empirical Research on Information Systems, School of Business, Örebro University, Örebro, Sweden
| | - Bo Wang
- Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway
| | - Maria Hägglund
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- MedTech Science & Innovation Centre, Uppsala University Hospital, Uppsala, Sweden
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Della Croce Y. Epistemic Injustice and Nonmaleficence. JOURNAL OF BIOETHICAL INQUIRY 2023; 20:447-456. [PMID: 37378755 PMCID: PMC10624719 DOI: 10.1007/s11673-023-10273-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 02/03/2023] [Indexed: 06/29/2023]
Abstract
Epistemic injustice has undergone a steady growth in the medical ethics literature throughout the last decade as many ethicists have found it to be a powerful tool for describing and assessing morally problematic situations in healthcare. However, surprisingly scarce attention has been devoted to how epistemic injustice relates to physicians' professional duties on a conceptual level. I argue that epistemic injustice, specifically testimonial, collides with physicians' duty of nonmaleficence and should thus be actively fought against in healthcare encounters on the ground of professional conduct. I do so by fleshing out how Fricker's conception of testimonial injustice conflicts with the duty of nonmaleficence as defined in Beauchamp and Childress on theoretical grounds. From there, I argue that testimonial injustice produces two distinct types of harm, epistemic and non-epistemic. Epistemic harms are harms inflicted by the physician to the patient qua knower, whereas non-epistemic harms are inflicted to the patient qua patient. This latter case holds serious clinical implications and represent a failure of the process of due care on the part of the physician. I illustrate this through examples taken from the literature on fibromyalgia syndrome and show how testimonial injustice causes wrongful harm to patients, making it maleficent practice. Finally, I conclude on why nonmaleficence as a principle will not be normatively enough to fully address the problem of epistemic injustice in healthcare but nevertheless may serve as a good starting point in attempting to do so.
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Affiliation(s)
- Yoann Della Croce
- Department of Political Science and International Relations, University of Geneva, 40 Boulevard du Pont d'Arve, 1205, Geneva, Switzerland.
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Meier-Diedrich E, Davidge G, Hägglund M, Kharko A, Lyckblad C, McMillan B, Blease C, Schwarz J. Changes in Documentation Due to Patient Access to Electronic Health Records: Protocol for a Scoping Review. JMIR Res Protoc 2023; 12:e46722. [PMID: 37639298 PMCID: PMC10495856 DOI: 10.2196/46722] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/16/2023] [Accepted: 07/05/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Internationally, patient-accessible electronic health records (PAEHRs) are increasingly being implemented. Despite reported benefits to patients, the innovation has prompted concerns among health care professionals (HCPs), including the possibility that access incurs a "dumbing down" of clinical records. Currently, no review has investigated empirical evidence of whether and how documentation changes after introducing PAEHRs. OBJECTIVE This paper presents the protocol for a scoping review examining potential subjective and objective changes in HCPs documentation after using PAEHRs. METHODS This scoping review will be carried out based on the framework of Arksey and O'Malley. Several databases will be used to conduct a literature search (APA PsycInfo, CINAHL, PubMed, and Web of Science Core Collection). Authors will participate in screening identified papers to explore the research questions: How do PAEHRs affect HCPs' documentation practices? and What subjective and objective changes to the clinical notes arise after patient access? Only studies that relate to actual use experiences, and not merely prior expectations about PAEHRs, will be selected in the review. Data abstraction will include but will not be limited to publication type, publication year, country, sample characteristics, setting, study aim, research question, and conclusions. The Mixed Methods Appraisal Tool will be used to assess the quality of the studies included. RESULTS The results from this scoping review will be presented as a narrative synthesis structured along the key themes of the corpus of evidence. Additional data will be prepared in charts or tabular format. We anticipate the results to be presented in a scoping review at a later date. They will be disseminated at scientific conferences and through publication in a peer-reviewed journal. CONCLUSIONS This is the first scoping review that considers potential change in documentation after implementation of PAEHRs. The results can potentially help affirm or refute prior opinions and expectations among various stakeholders about the use of PAEHRs and thereby help to address uncertainties. Results may help to provide guidance to clinicians in writing notes and thus have immediate practical relevance to care. In addition, the review will help to identify any substantive research gaps in this field of research. In the longer term, our findings may contribute to the development of shared documentation guidelines, which in turn are central to improving patient communication and safety. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/46722.
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Affiliation(s)
- Eva Meier-Diedrich
- Brandenburg Medical School, Immanuel Hospital Rüdersdorf, University Clinic for Psychiatry and Psychotherapy, Rüdersdorf, Germany
- Faculty for Health Sciences, Brandenburg Medical School, Neuruppin, Germany
| | - Gail Davidge
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom
| | - Maria Hägglund
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anna Kharko
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Camilla Lyckblad
- Department of Archives, Libraries, and Museums, Uppsala University, Uppsala, Sweden
| | - Brian McMillan
- Centre for Primary Care and Health Services Research, University of Manchester, Manchester, United Kingdom
| | - Charlotte Blease
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Julian Schwarz
- Brandenburg Medical School, Immanuel Hospital Rüdersdorf, University Clinic for Psychiatry and Psychotherapy, Rüdersdorf, Germany
- Faculty for Health Sciences, Brandenburg Medical School, Neuruppin, Germany
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Brown CE, Marshall AR, Snyder CR, Cueva KL, Pytel CC, Jackson SY, Golden SH, Campelia GD, Horne DJ, Doll KM, Curtis JR, Young BA. Perspectives About Racism and Patient-Clinician Communication Among Black Adults With Serious Illness. JAMA Netw Open 2023; 6:e2321746. [PMID: 37405773 PMCID: PMC10323709 DOI: 10.1001/jamanetworkopen.2023.21746] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/15/2023] [Indexed: 07/06/2023] Open
Abstract
Importance Black patients with serious illness experience higher-intensity care at the end of life. Little research has used critical, race-conscious approaches to examine factors associated with these outcomes. Objective To investigate the lived experiences of Black patients with serious illness and how various factors may be associated with patient-clinician communication and medical decision-making. Design, Setting, and Participants In this qualitative study, one-on-one, semistructured interviews were conducted with 25 Black patients with serious illness hospitalized at an urban academic medical center in Washington State between January 2021 and February 2023. Patients were asked to discuss experiences with racism, how those experiences affected the way they communicated with clinicians, and how racism impacted medical decision-making. Public Health Critical Race Praxis was used as framework and process. Main Outcomes and Measures The experience and of racism and its association, as described by Black patients who had serious illness, with patient-clinician communication and medical decision-making within a racialized health care setting. Results A total of 25 Black patients (mean [SD] age, 62.0 [10.3] years; 20 males [80.0%]) with serious illness were interviewed. Participants had substantial socioeconomic disadvantage, with low levels of wealth (10 patients with 0 assets [40.0%]), income (annual income <$25 000 among 19 of 24 patients with income data [79.2%]), educational attainment (mean [SD] 13.4 [2.7] years of schooling), and health literacy (mean [SD] score in the Rapid Estimate of Adult Literacy in Medicine-Short Form, 5.8 [2.0]). Participants reported high levels of medical mistrust and high frequency of discrimination and microaggressions experienced in health care settings. Participants reported epistemic injustice as the most common manifestation of racism: silencing of their own knowledge and lived experiences about their bodies and illness by health care workers. Participants reported that these experiences made them feel isolated and devalued, especially if they had intersecting, marginalized identities, such as being underinsured or unhoused. These experiences were associated with exacerbation of existing medical mistrust and poor patient-clinician communication. Participants described various mechanisms of self-advocacy and medical decision-making based on prior experiences with mistreatment from health care workers and medical trauma. Conclusions and Relevance This study found that Black patients' experiences with racism, specifically epistemic injustice, were associated with their perspectives on medical care and decision-making during serious illness and end of life. These findings suggest that race-conscious, intersectional approaches may be needed to improve patient-clinician communication and support Black patients with serious illness to alleviate the distress and trauma of racism as these patients near the end of life.
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Affiliation(s)
- Crystal E. Brown
- Cambia Palliative Care Center of Excellence at UW Medicine, Seattle
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle
- Department of Bioethics and Humanities, School of Medicine, University of Washington, Seattle
| | - Arisa R. Marshall
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle
| | - Cyndy R. Snyder
- Department of Family Medicine, Center for Health Workforce Studies, School of Medicine, University of Washington, Seattle
| | | | - Christina C. Pytel
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle
| | | | - Sherita H. Golden
- Division of Endocrinology, Diabetes, and Metabolism, John Hopkins University, Baltimore, Maryland
| | - Georgina D. Campelia
- Department of Bioethics and Humanities, School of Medicine, University of Washington, Seattle
| | - David J. Horne
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle
| | - Kemi M. Doll
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Washington, Seattle
| | - J. Randall Curtis
- Cambia Palliative Care Center of Excellence at UW Medicine, Seattle
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, University of Washington, Seattle
| | - Bessie A. Young
- Division of Nephrology, Department of Medicine, University of Washington, Seattle
- Justice, Equity, Diversity, and Inclusion Center for Transformational Research, University of Washington, Seattle
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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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Salisbury H. Helen Salisbury: Confusion over patient access to notes. BMJ 2022; 379:o2607. [PMID: 36318976 DOI: 10.1136/bmj.o2607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Acceptability of Health Information Exchange and Patient Portal Use in Depression Care Among Underrepresented Patients. J Gen Intern Med 2022; 37:3947-3955. [PMID: 35132548 PMCID: PMC8821856 DOI: 10.1007/s11606-022-07427-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/19/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Depression is often untreated or undertreated, particularly among underrepresented groups, such as racial and ethnic minorities, and individuals of lower socioeconomic status. Electronic health information exchange (HIE) is a recommended practice to improve care coordination and encourage patient engagement in services, but it remains underutilized in depression care. Understanding factors affecting acceptance and adoption of this technology among underrepresented patient populations is needed to increase dissemination of HIE within mental health treatment. OBJECTIVE The present study aims to identify patient barriers and facilitators towards the acceptance of HIE within the context of depression treatment and to examine how HIE impacts depression-related care coordination and patient activation. DESIGN Semi-structured qualitative interviews were conducted with 27 patients. PARTICIPANTS Respondents were English-speaking adults (> 18) receiving depression treatment within a large, safety-net primary care clinic. APPROACH A grounded theory approach was used to code and analyze data for emergent themes. Thematic analysis was guided by the Unified Theory of Acceptance and Use of Technology, a leading informatics theory used to predict end-user adoption of technology. KEY RESULTS Respondents reported that HIE made depression care more convenient, transparent, and trustworthy. Though respondents desired greater access to their health records, stigma surrounding depression inhibited acceptance of electronic communication and information sharing. Confusing electronic interface also diminished perceived benefits of HIE. CONCLUSION(S) Respondents desire greater transparency in their depression care. While HIE was perceived to improve the overall quality of depression care, stigma associated with mental illness undermined more robust adoption of this technology among underserved populations.
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Abstract
Rapid, convenient, and full access to personal electronic health records is a key part of empowering patients to manage their health and collaborate with healthcare, argue Maria Hägglund and colleagues
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Affiliation(s)
- Maria Hägglund
- Healthcare Sciences and E-health, Department of Women's and Children's Health, Uppsala University, Sweden
| | - Brian McMillan
- Centre for Primary Care and Health Services Research, University of Manchester, UK
| | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, New Zealand
- Waitemata District Health Board, New Zealand
| | - Charlotte Blease
- General Medicine and Primary Care Research, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Blease C. Sharing online clinical notes with patients: implications for nocebo effects and health equity. JOURNAL OF MEDICAL ETHICS 2022; 49:medethics-2022-108413. [PMID: 35918134 DOI: 10.1136/jme-2022-108413] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 07/22/2022] [Indexed: 06/15/2023]
Abstract
Patients in around 20 countries worldwide are now offered online access to at least some of their medical records. Access includes test results, medication lists, referral information, and/or the very words written by clinicians (so-called 'open notes'). In this paper, I discuss the possibility of one unintended negative consequence of patient access to their clinical notes-the potential to increase 'nocebo effects'. A growing body of research shows that nocebo effects arise by engaging perceptual and cognitive processes that influence negative expectancies, and as a consequence, adverse health effects. Studies show that increased awareness about the side effects of medications, the framing of information and the socioemotional context of care can increase the risk of nocebo effects. Connecting research into the nocebo effect with open notes provides preliminary support for the hypothesis that patient access to clinical notes might be a forum for facilitating unwanted nocebo effects. Furthermore, current findings indicate that we might expect to see systematic differences in how nocebo effects are experienced among different patient populations. The ethical implications of the tension between transparency and the potential for harm are discussed, with an emphasis on what open notes might mean for justice and equity in clinical care for a range of already marginalised patient populations. I argue that to resolve these challenges does not thereby justify 'closed notes', and conclude with suggestions for how health systems and clinicians might adapt to this innovation to reduce the risk of potential nocebo effects arising via this novel route.
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Affiliation(s)
- Charlotte Blease
- Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02115, USA
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Hagström J, Blease C, Haage B, Scandurra I, Hansson S, Hägglund M. Views, Use, and Experiences of Online Access to Pediatric Electronic Health Records for Children, Adolescents, and Parents: Scoping Review (Preprint). J Med Internet Res 2022; 24:e40328. [DOI: 10.2196/40328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/12/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022] Open
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McMillan J. Trust and medical ethics. JOURNAL OF MEDICAL ETHICS 2022; 48:153. [PMID: 35232769 DOI: 10.1136/medethics-2022-108199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
- John McMillan
- Bioethics Centre, University of Otago, Dunedin, Otago, New Zealand
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Kassam I, Shin HD, Durocher K, Lo B, Shen N, Mehta R, Sockalingam S, Wiljer D, Gratzer D, Sequeira L, Strudwick G. "I think it's something that we should lean in to": The use of OpenNotes in Canadian psychiatric care contexts by clinicians. Digit Health 2022; 8:20552076221144106. [PMID: 36532111 PMCID: PMC9751166 DOI: 10.1177/20552076221144106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 11/18/2022] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND OpenNotes is the concept of patients having access to their health records and clinical notes in a digital form. In psychiatric settings, clinicians often feel uncomfortable with this concept, and require support during implementation. OBJECTIVE This study utilizes an implementation science lens to explore clinicians' perceptions about using OpenNotes in Canadian psychiatric care contexts. The findings are intended to inform the co-design of implementation strategies to support the implementation of OpenNotes in Canadian contexts. METHOD This qualitative descriptive study employed semi-structured interviews which were completed among health professionals of varying disciplines working in direct care psychiatric roles. Data analysis consisted of a qualitative directed content analysis using themes outlined from an international Delphi study of mental health clinicians and experts. Ethical approval was obtained from the Centre for Addiction and Mental Health and the University of Toronto. RESULTS In total, 23 clinicians from psychiatric settings participated in the interviews. Many of the themes outlined within the Delphi study were voiced. Benefits included enhancements to patient recall, and empowerment, improvements to care quality, strengthened relational effects and effects on professional autonomy and efficiencies. Despite the anticipated benefits of OpenNotes, identified challenges pertained to clarity surrounding exemption policies, training on patient facing notes, managing disagreements, and educating patients on reading clinical notes. CONCLUSION Many benefits and challenges were identified for adopting OpenNotes in Canadian psychiatric settings. Future work should focus on applying implementation frameworks to develop interventions that address the identified challenges.
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Affiliation(s)
- Iman Kassam
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Hwayeon Danielle Shin
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Keri Durocher
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Brian Lo
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- UHN Digital, University Health Network, Toronto, Ontario, Canada
| | - Nelson Shen
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Rohan Mehta
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sanjeev Sockalingam
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David Wiljer
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- UHN Digital, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - David Gratzer
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lydia Sequeira
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Gillian Strudwick
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Schwarz J, Bärkås A, Blease C, Collins L, Hägglund M, Markham S, Hochwarter S. Sharing Clinical Notes and Electronic Health Records With People Affected by Mental Health Conditions: Scoping Review. JMIR Ment Health 2021; 8:e34170. [PMID: 34904956 PMCID: PMC8715358 DOI: 10.2196/34170] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 10/25/2021] [Accepted: 10/31/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Electronic health records (EHRs) are increasingly implemented internationally, whereas digital sharing of EHRs with service users (SUs) is a relatively new practice. Studies of patient-accessible EHRs (PAEHRs)-often referred to as open notes-have revealed promising results within general medicine settings. However, studies carried out in mental health care (MHC) settings highlight several ethical and practical challenges that require further exploration. OBJECTIVE This scoping review aims to map available evidence on PAEHRs in MHC. We seek to relate findings with research from other health contexts, to compare different stakeholders' perspectives, expectations, actual experiences with PAEHRs, and identify potential research gaps. METHODS A systematic scoping review was performed using 6 electronic databases. Studies that focused on the digital sharing of clinical notes or EHRs with people affected by mental health conditions up to September 2021 were included. The Mixed Methods Appraisal Tool was used to assess the quality of the studies. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Extension for Scoping Reviews guided narrative synthesis and reporting of findings. RESULTS Of the 1034 papers screened, 31 were included in this review. The studies used mostly qualitative methods or surveys and were predominantly published after 2018 in the United States. PAEHRs were examined in outpatient (n=29) and inpatient settings (n=11), and a third of all research was conducted in Veterans Affairs Mental Health. Narrative synthesis allowed the integration of findings according to the different stakeholders. First, SUs reported mainly positive experiences with PAEHRs, such as increased trust in their clinician, health literacy, and empowerment. Negative experiences were related to inaccurate notes, disrespectful language use, or uncovering of undiscussed diagnoses. Second, for health care professionals, concerns outweigh the benefits of sharing EHRs, including an increased clinical burden owing to more documentation efforts and possible harm triggered by reading the notes. Third, care partners gained a better understanding of their family members' mental problems and were able to better support them when they had access to their EHR. Finally, policy stakeholders and experts addressed ethical challenges and recommended the development of guidelines and trainings to better prepare both clinicians and SUs on how to write and read notes. CONCLUSIONS PAEHRs in MHC may strengthen user involvement, patients' autonomy, and shift medical treatment to a coproduced process. Acceptance issues among health care professionals align with the findings from general health settings. However, the corpus of evidence on digital sharing of EHRs with people affected by mental health conditions is limited. Above all, further research is needed to examine the clinical effectiveness, efficiency, and implementation of this sociotechnical intervention.
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Affiliation(s)
- Julian Schwarz
- Department of Psychiatry and Psychotherapy, Immanuel Klinik Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany.,Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| | - Annika Bärkås
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Charlotte Blease
- General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, United States
| | - Lorna Collins
- Social Science Research Unit, University College London, London, United Kingdom
| | - Maria Hägglund
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Sarah Markham
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Stefan Hochwarter
- Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany.,Department of Computer Science, Norwegian University of Science and Technology, Trondheim, Norway
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Blease C, Kharko A, Hägglund M, O’Neill S, Wachenheim D, Salmi L, Harcourt K, Locher C, DesRoches CM, Torous J. The benefits and harms of open notes in mental health: A Delphi survey of international experts. PLoS One 2021; 16:e0258056. [PMID: 34644320 PMCID: PMC8513879 DOI: 10.1371/journal.pone.0258056] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 09/16/2021] [Indexed: 11/19/2022] Open
Abstract
IMPORTANCE As of April 5, 2021, as part of the 21st Century Cures Act, new federal rules in the U.S. mandate that providers offer patients access to their online clinical records. OBJECTIVE To solicit the view of an international panel of experts on the effects on mental health patients, including possible benefits and harms, of accessing their clinical notes. DESIGN An online 3-round Delphi poll. SETTING Online. PARTICIPANTS International experts identified as clinicians, chief medical information officers, patient advocates, and informaticians with extensive experience and/or research knowledge about patient access to mental health notes. MAIN OUTCOMES, AND MEASURES An expert-generated consensus on the benefits and risks of sharing mental health notes with patients. RESULTS A total of 70 of 92 (76%) experts from 6 countries responded to Round 1. A qualitative review of responses yielded 88 distinct items: 42 potential benefits, and 48 potential harms. A total of 56 of 70 (80%) experts responded to Round 2, and 52 of 56 (93%) responded to Round 3. Consensus was reached on 65 of 88 (74%) of survey items. There was consensus that offering online access to mental health notes could enhance patients' understanding about their diagnosis, care plan, and rationale for treatments, and that access could enhance patient recall and sense of empowerment. Experts also agreed that blocking mental health notes could lead to greater harms including increased feelings of stigmatization. However, panelists predicted there could be an increase in patients demanding changes to their clinical notes, and that mental health clinicians would be less detailed/accurate in documentation. CONCLUSIONS AND RELEVANCE This iterative process of survey responses and ratings yielded consensus that there would be multiple benefits and few harms to patients from accessing their mental health notes. Questions remain about the impact of open notes on professional autonomy, and further empirical work into this practice innovation is warranted.
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Affiliation(s)
- Charlotte Blease
- General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- * E-mail:
| | - Anna Kharko
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | - Maria Hägglund
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Stephen O’Neill
- General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Deborah Wachenheim
- General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Liz Salmi
- General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Kendall Harcourt
- General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Cosima Locher
- Department of Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Catherine M. DesRoches
- General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - John Torous
- Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
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Patients' Access to Their Psychiatric Notes: Current Policies and Practices in Sweden. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179140. [PMID: 34501730 PMCID: PMC8431356 DOI: 10.3390/ijerph18179140] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/21/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022]
Abstract
Patients’ access to electronic health records (EHRs) is debated worldwide, and access to psychiatry records is even more criticized. There is a nationwide service in Sweden which offers all citizens the opportunity to read their EHR, including clinical notes. This study aims to explore Swedish national and local policy regulations regarding patients’ access to their psychiatric notes and describe to what extent patients currently are offered access to them. The rationale behind the study is that current policies and current practices may differ between the 21 self-governing regions, although there is a national regulation. We gathered web-based information from policy documents and regulations from each region’s website. We also conducted key stakeholder interviews with respondents from the regions and cross-regional private care providers, using a qualitative approach. The results show that 17 of 21 regions share psychiatric notes with patients, where forensic psychiatric care was the most excluded psychiatric care setting. All private care providers reported that they mainly follow the regions’ guidelines. Our findings show that regional differences concerning sharing psychiatric notes persist, despite Swedish regulations and a national policy that stipulates equal care for everyone. The differences, however, appear to have decreased over time, and we report evidence that the regions are moving toward increased transparency for psychiatry patients.
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