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Wurster F, Herrmann C, Beckmann M, Cecon-Stabel N, Dittmer K, Hansen T, Jaschke J, Köberlein-Neu J, Okumu MR, Pfaff H, Rusniok C, Karbach U. Differences in changes of data completeness after the implementation of an electronic medical record in three surgical departments of a German hospital-a longitudinal comparative document analysis. BMC Med Inform Decis Mak 2024; 24:258. [PMID: 39285457 PMCID: PMC11404022 DOI: 10.1186/s12911-024-02667-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 09/05/2024] [Indexed: 09/22/2024] Open
Abstract
PURPOSE The European health data space promises an efficient environment for research and policy-making. However, this data space is dependent on high data quality. The implementation of electronic medical record systems has a positive impact on data quality, but improvements are not consistent across empirical studies. This study aims to analyze differences in the changes of data quality and to discuss these against distinct stages of the electronic medical record's adoption process. METHODS Paper-based and electronic medical records from three surgical departments were compared, assessing changes in data quality after the implementation of an electronic medical record system. Data quality was operationalized as completeness of documentation. Ten information that must be documented in both record types (e.g. vital signs) were coded as 1 if they were documented, otherwise as 0. Chi-Square-Tests were used to compare percentage completeness of these ten information and t-tests to compare mean completeness per record type. RESULTS A total of N = 659 records were analyzed. Overall, the average completeness improved in the electronic medical record, with a change from 6.02 (SD = 1.88) to 7.2 (SD = 1.77). At the information level, eight information improved, one deteriorated and one remained unchanged. At the level of departments, changes in data quality show expected differences. CONCLUSION The study provides evidence that improvements in data quality could depend on the process how the electronic medical record is adopted in the affected department. Research is needed to further improve data quality through implementing new electronical medical record systems or updating existing ones.
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Affiliation(s)
- Florian Wurster
- Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Chair of Quality Development and Evaluation in Rehabilitation, University of Cologne, Eupener Str. 129, 50933, Cologne, Germany.
| | - Christin Herrmann
- Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Chair of Quality Development and Evaluation in Rehabilitation, University of Cologne, Eupener Str. 129, 50933, Cologne, Germany
| | - Marina Beckmann
- Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Chair of Quality Development and Evaluation in Rehabilitation, University of Cologne, Eupener Str. 129, 50933, Cologne, Germany
| | - Natalia Cecon-Stabel
- Medical Faculty, Unit of Child Health Services Research, Clinic of General Pediatrics, Neonatology and Pediatric Cardiology, University Hospital Düsseldorf, Heinrich-Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Kerstin Dittmer
- Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Chair of Quality Development and Evaluation in Rehabilitation, University of Cologne, Eupener Str. 129, 50933, Cologne, Germany
| | - Till Hansen
- Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Chair of Quality Development and Evaluation in Rehabilitation, University of Cologne, Eupener Str. 129, 50933, Cologne, Germany
| | - Julia Jaschke
- Center for Health Economics and Health Services Research, University of Wuppertal, Rainer-Gruenter-Str. 21, 42119, Wuppertal, Germany
| | - Juliane Köberlein-Neu
- Center for Health Economics and Health Services Research, University of Wuppertal, Rainer-Gruenter-Str. 21, 42119, Wuppertal, Germany
| | - Mi-Ran Okumu
- Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Chair of Quality Development and Evaluation in Rehabilitation, University of Cologne, Eupener Str. 129, 50933, Cologne, Germany
| | - Holger Pfaff
- Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Chair of Quality Development and Evaluation in Rehabilitation, University of Cologne, Eupener Str. 129, 50933, Cologne, Germany
| | - Carsten Rusniok
- Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Chair of Quality Development and Evaluation in Rehabilitation, University of Cologne, Eupener Str. 129, 50933, Cologne, Germany
| | - Ute Karbach
- Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Chair of Quality Development and Evaluation in Rehabilitation, University of Cologne, Eupener Str. 129, 50933, Cologne, Germany
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Nielsen MS, Steinsbekk A, Nøst TH. Development of Recommendations for the Digital Sharing of Notes With Adolescents in Mental Health Care: Delphi Study. JMIR Ment Health 2024; 11:e57965. [PMID: 38860592 PMCID: PMC11185290 DOI: 10.2196/57965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 06/12/2024] Open
Abstract
Background In many countries, health care professionals are legally obliged to share information from electronic health records with patients. However, concerns have been raised regarding the sharing of notes with adolescents in mental health care, and health care professionals have called for recommendations to guide this practice. Objective The aim was to reach a consensus among authors of scientific papers on recommendations for health care professionals' digital sharing of notes with adolescents in mental health care and to investigate whether staff at child and adolescent specialist mental health care clinics agreed with the recommendations. Methods A Delphi study was conducted with authors of scientific papers to reach a consensus on recommendations. The process of making the recommendations involved three steps. First, scientific papers meeting the eligibility criteria were identified through a PubMed search where the references were screened. Second, the results from the included papers were coded and transformed into recommendations in an iterative process. Third, the authors of the included papers were asked to provide feedback and consider their agreement with each of the suggested recommendations in two rounds. After the Delphi process, a cross-sectional study was conducted among staff at specialist child and adolescent mental health care clinics to assess whether they agreed with the recommendations that reached a consensus. Results Of the 84 invited authors, 27 responded. A consensus was reached on 17 recommendations on areas related to digital sharing of notes with adolescents in mental health care. The recommendations considered how to introduce digital access to notes, write notes, and support health care professionals, and when to withhold notes. Of the 41 staff members at child and adolescent specialist mental health care clinics, 60% or more agreed with the 17 recommendations. No consensus was reached regarding the age at which adolescents should receive digital access to their notes and the timing of digitally sharing notes with parents. Conclusions A total of 17 recommendations related to key aspects of health care professionals' digital sharing of notes with adolescents in mental health care achieved consensus. Health care professionals can use these recommendations to guide their practice of sharing notes with adolescents in mental health care. However, the effects and experiences of following these recommendations should be tested in clinical practice.
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Affiliation(s)
- Martine Stecher Nielsen
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Norwegian Centre for E-health Research, Tromsø, Norway
| | - Torunn Hatlen Nøst
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Anaesthesia and Intensive Care, Clinical Research Facility, St. Olavs hospital, Trondheim, Norway
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Meier-Diedrich E, Neumann K, Heinze M, Schwarz J. [Attitudes and Expectations of Psychological and Medical Psychotherapists Towards Open Notes: Analysis of Qualitative Survey Responses]. PSYCHIATRISCHE PRAXIS 2024. [PMID: 38810902 DOI: 10.1055/a-2320-8929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
OBJECTIVE This study explores attitudes and expectations of psychotherapists (PT) towards the introduction of digital patient access to clinical notes ("Open Notes"; ON)), including the advantages and disadvantages in psychotherapeutic practice. METHODS As part of the PEPPPSY study, an online survey was conducted. Free text responses (n = 107) were qualitatively analysed using thematic analysis. RESULTS 129 psychological and medical PT took part in the survey. PT saw advantages such as transparency and patient-centred documentation, but feared disadvantages for the therapeutic relationship and an increased workload through the implementation of ON. Concerns were raised about data security and negative effects on treatment. Recommendations for implementation include patient-specific access adaptations and guided access. CONCLUSION PT are ambivalent about ON. Further research and guidelines for the use of ON in psychotherapy are needed.
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Affiliation(s)
- Eva Meier-Diedrich
- Klinik für Psychiatrie und Psychotherapie, Zentrum für Seelische Gesundheit, Immanuel Klinik Rüdersdorf, Medizinische Hochschule Brandenburg, Rüdersdorf
- Fakultät für Gesundheitswissenschaften Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin
| | | | - Martin Heinze
- Klinik für Psychiatrie und Psychotherapie, Zentrum für Seelische Gesundheit, Immanuel Klinik Rüdersdorf, Medizinische Hochschule Brandenburg, Rüdersdorf
- Fakultät für Gesundheitswissenschaften Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin
- Zentrum für Versorgungsforschung Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Rüdersdorf
| | - Julian Schwarz
- Klinik für Psychiatrie und Psychotherapie, Zentrum für Seelische Gesundheit, Immanuel Klinik Rüdersdorf, Medizinische Hochschule Brandenburg, Rüdersdorf
- Fakultät für Gesundheitswissenschaften Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Neuruppin
- Zentrum für Versorgungsforschung Brandenburg, Medizinische Hochschule Brandenburg Theodor Fontane, Rüdersdorf
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Martens E, Haase HU, Mastella G, Henkel A, Spinner C, Hahn F, Zou C, Fava Sanches A, Allescher J, Heid D, Strauss E, Maier MM, Lachmann M, Schmidt G, Westphal D, Haufe T, Federle D, Rueckert D, Boeker M, Becker M, Laugwitz KL, Steger A, Müller A. Smart hospital: achieving interoperability and raw data collection from medical devices in clinical routine. Front Digit Health 2024; 6:1341475. [PMID: 38510279 PMCID: PMC10951085 DOI: 10.3389/fdgth.2024.1341475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/13/2024] [Indexed: 03/22/2024] Open
Abstract
Introduction Today, modern technology is used to diagnose and treat cardiovascular disease. These medical devices provide exact measures and raw data such as imaging data or biosignals. So far, the Broad Integration of These Health Data into Hospital Information Technology Structures-Especially in Germany-is Lacking, and if data integration takes place, only non-Evaluable Findings are Usually Integrated into the Hospital Information Technology Structures. A Comprehensive Integration of raw Data and Structured Medical Information has not yet Been Established. The aim of this project was to design and implement an interoperable database (cardio-vascular-information-system, CVIS) for the automated integration of al medical device data (parameters and raw data) in cardio-vascular medicine. Methods The CVIS serves as a data integration and preparation system at the interface between the various devices and the hospital IT infrastructure. In our project, we were able to establish a database with integration of proprietary device interfaces, which could be integrated into the electronic health record (EHR) with various HL7 and web interfaces. Results In the period between 1.7.2020 and 30.6.2022, the data integrated into this database were evaluated. During this time, 114,858 patients were automatically included in the database and medical data of 50,295 of them were entered. For technical examinations, more than 4.5 million readings (an average of 28.5 per examination) and 684,696 image data and raw signals (28,935 ECG files, 655,761 structured reports, 91,113 x-ray objects, 559,648 ultrasound objects in 54 different examination types, 5,000 endoscopy objects) were integrated into the database. Over 10.2 million bidirectional HL7 messages (approximately 14,000/day) were successfully processed. 98,458 documents were transferred to the central document management system, 55,154 materials (average 7.77 per order) were recorded and stored in the database, 21,196 diagnoses and 50,353 services/OPS were recorded and transferred. On average, 3.3 examinations per patient were recorded; in addition, there are an average of 13 laboratory examinations. Discussion Fully automated data integration from medical devices including the raw data is feasible and already creates a comprehensive database for multimodal modern analysis approaches in a short time. This is the basis for national and international projects by extracting research data using FHIR.
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Affiliation(s)
- Eimo Martens
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
- European Reference Network Guard Heart, European Union, Amsterdam, Netherlands
| | - Hans-Ulrich Haase
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
| | - Giulio Mastella
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
| | - Andreas Henkel
- TUM School of Medicine and Health, Department of Clinical Medicine—Department of Information Technology, University Medical Center, Technical University of Munich, Munich, Germany
- IHE Deutschland e.V, Berlin, Germany
| | - Christoph Spinner
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine II, University Medical Center, Technical University of Munich, Munich, Germany
| | - Franziska Hahn
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
| | - Congyu Zou
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
| | - Augusto Fava Sanches
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
| | - Julia Allescher
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
| | - Daniel Heid
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
| | - Elena Strauss
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
| | - Melanie-Maria Maier
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
| | - Mark Lachmann
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
| | - Georg Schmidt
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
- Working Group of Medical Ethics Committees in the Federal Republic of Germany e.V., Berlin, Germany
- TUM School of Medicine and Health, Department of Clinical Medicine—Ethics Committee, University Medical Center, Technical University of Munich, Munich, Germany
| | - Dominik Westphal
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Human Genetics, University Medical Center, Technical University of Munich, Munich, Germany
| | - Tobias Haufe
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
| | - David Federle
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
| | - Daniel Rueckert
- TUM School of Medicine and Health, Center for Digital Health & Technology—Institute for Artificial Intelligence and Informatics in Medicine, University Medical Center, Technical University of Munich, Munich, Germany
- Department of Computing, Imperial College London, London, United Kingdom
| | - Martin Boeker
- TUM School of Medicine and Health, Center for Digital Health & Technology—Institute for Artificial Intelligence and Informatics in Medicine, University Medical Center, Technical University of Munich, Munich, Germany
| | - Matthias Becker
- Development Department, Fleischhacker GmbH & Co, Schwerte, Germany
| | - Karl-Ludwig Laugwitz
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
- German Center of Cardio-Vascular-Research (DZHK), Berlin, Germany
| | - Alexander Steger
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
- German Center of Cardio-Vascular-Research (DZHK), Berlin, Germany
| | - Alexander Müller
- TUM School of Medicine and Health, Department of Clinical Medicine—Clinical Department for Internal Medicine I, University Medical Center, Technical University of Munich, Munich, Germany
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Wurster F, Beckmann M, Cecon-Stabel N, Dittmer K, Hansen TJ, Jaschke J, Köberlein-Neu J, Okumu MR, Rusniok C, Pfaff H, Karbach U. The Implementation of an Electronic Medical Record in a German Hospital and the Change in Completeness of Documentation: Longitudinal Document Analysis. JMIR Med Inform 2024; 12:e47761. [PMID: 38241076 PMCID: PMC10837754 DOI: 10.2196/47761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 08/10/2023] [Accepted: 10/23/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Electronic medical records (EMR) are considered a key component of the health care system's digital transformation. The implementation of an EMR promises various improvements, for example, in the availability of information, coordination of care, or patient safety, and is required for big data analytics. To ensure those possibilities, the included documentation must be of high quality. In this matter, the most frequently described dimension of data quality is the completeness of documentation. In this regard, little is known about how and why the completeness of documentation might change after the implementation of an EMR. OBJECTIVE This study aims to compare the completeness of documentation in paper-based medical records and EMRs and to discuss the possible impact of an EMR on the completeness of documentation. METHODS A retrospective document analysis was conducted, comparing the completeness of paper-based medical records and EMRs. Data were collected before and after the implementation of an EMR on an orthopaedical ward in a German academic teaching hospital. The anonymized records represent all treated patients for a 3-week period each. Unpaired, 2-tailed t tests, chi-square tests, and relative risks were calculated to analyze and compare the mean completeness of the 2 record types in general and of 10 specific items in detail (blood pressure, body temperature, diagnosis, diet, excretions, height, pain, pulse, reanimation status, and weight). For this purpose, each of the 10 items received a dichotomous score of 1 if it was documented on the first day of patient care on the ward; otherwise, it was scored as 0. RESULTS The analysis consisted of 180 medical records. The average completeness was 6.25 (SD 2.15) out of 10 in the paper-based medical record, significantly rising to an average of 7.13 (SD 2.01) in the EMR (t178=-2.469; P=.01; d=-0.428). When looking at the significant changes of the 10 items in detail, the documentation of diet (P<.001), height (P<.001), and weight (P<.001) was more complete in the EMR, while the documentation of diagnosis (P<.001), excretions (P=.02), and pain (P=.008) was less complete in the EMR. The completeness remained unchanged for the documentation of pulse (P=.28), blood pressure (P=.47), body temperature (P=.497), and reanimation status (P=.73). CONCLUSIONS Implementing EMRs can influence the completeness of documentation, with a possible change in both increased and decreased completeness. However, the mechanisms that determine those changes are often neglected. There are mechanisms that might facilitate an improved completeness of documentation and could decrease or increase the staff's burden caused by documentation tasks. Research is needed to take advantage of these mechanisms and use them for mutual profit in the interests of all stakeholders. TRIAL REGISTRATION German Clinical Trials Register DRKS00023343; https://drks.de/search/de/trial/DRKS00023343.
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Affiliation(s)
- Florian Wurster
- Chair of Quality Development and Evaluation in Rehabilitation, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Marina Beckmann
- Chair of Quality Development and Evaluation in Rehabilitation, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Natalia Cecon-Stabel
- Chair of Quality Development and Evaluation in Rehabilitation, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Kerstin Dittmer
- Chair of Quality Development and Evaluation in Rehabilitation, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Till Jes Hansen
- Chair of Quality Development and Evaluation in Rehabilitation, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julia Jaschke
- Center for Health Economics and Health Services Research, University of Wuppertal, Wuppertal, Germany
| | - Juliane Köberlein-Neu
- Center for Health Economics and Health Services Research, University of Wuppertal, Wuppertal, Germany
| | - Mi-Ran Okumu
- Chair of Quality Development and Evaluation in Rehabilitation, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Carsten Rusniok
- Chair of Quality Development and Evaluation in Rehabilitation, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Holger Pfaff
- Chair of Quality Development and Evaluation in Rehabilitation, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ute Karbach
- Chair of Quality Development and Evaluation in Rehabilitation, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, Faculty of Human Sciences & Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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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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Schwarz J, Neumann K, Meier-Diedrich E, Mühlensiepen F, Hochwarter S, Blease C. Psychotherapists' views on open notes: An online survey from Germany. Digit Health 2024; 10:20552076241271813. [PMID: 39291155 PMCID: PMC11406606 DOI: 10.1177/20552076241271813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 07/04/2024] [Indexed: 09/19/2024] Open
Abstract
Background In an increasing number of countries, patients are given online record access (ORA) to their clinical notes ("open notes"). In many places, psychotherapy notes are exempt, even if patients explicitly wish to read them. Previous research suggests that psychotherapists (PTs) have reservations that are not yet fully understood. Objective To investigate the attitudes and perceived effects of open notes on psychotherapeutic care, patients, and individual psychotherapeutic practice in Germany. Methods Psychological and medical therapists were invited to participate in a national online survey. Sociodemographic characteristics such as gender, age, professional group, and psychotherapeutic school were gathered. Descriptive statistics were used to analyze the 51-item survey. Results 129 PTs completed the survey. Only a small proportion of respondents (30 out of 129, 23.3%) suspected that open notes would improve the efficiency of psychotherapeutic care. On the one hand, participants assumed that patients gain more control over their treatment (59 out of 129, 45.7%) and are better able to remember therapy goals (55 out of 129, 42.6%), although this was considered unlikely to lead to greater engagement in the therapy process (94 out of 129, 72.9%). On the other hand, PTs expected patients to misunderstand their notes, feel offended (98 out of 129, 76.0%), and approach them with questions (107 out of 129, 82.9%) or requests for changes (94 out of 129, 72.9%). The respondents also anticipated being less honest when writing (95 out of 129, 73.6%) and reported they needed more time for documentation (99 out of 129, 76.7%). A meaningful use of open notes for working with relatives was envisaged (101 out of 129, 78.3%). Conclusion PTs in Germany tend to have a negative attitude towards patients' ORA on open notes. Further research on clinical efficacy and feasibility is necessary to demonstrate whether open notes add value in the context of psychotherapy.
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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, Rüdersdorf, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
- Faculty of Health Sciences Brandenburg, Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| | - Katharina Neumann
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
- Department for Addictive Disorders, Salus Hospital Lindow, Lindow, Germany
| | - Eva Meier-Diedrich
- Department of Psychiatry and Psychotherapy, Center for Mental Health, Immanuel Hospital Rüdersdorf, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Felix Mühlensiepen
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
- Faculty of Health Sciences Brandenburg, Center for Health Services Research, Brandenburg Medical School Theodor Fontane, Rüdersdorf, Germany
| | - Stefan Hochwarter
- HEALTH - Institute for Biomedical Research and Technologies, Joanneum Research Forschungsgesellschaft mbH, Graz, Austria
| | - Charlotte Blease
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Division of General Medicine Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA
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Ling S, Kassam I, Haider S, Lo B, Strudwick G. Pre-implementation perceptions of clinicians regarding a patient portal in inpatient addictions settings: A qualitative descriptive study. Int J Med Inform 2023; 180:105278. [PMID: 37922661 DOI: 10.1016/j.ijmedinf.2023.105278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 10/06/2023] [Accepted: 10/28/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Patient portals have been implemented in many organizations to support patient engagement and empowerment. However, their use in inpatient mental health and addiction settings is relatively new and has not been extensively studied. To address this gap, this study explored clinician perspectives of implementing a patient portal in inpatient addiction settings. METHODS The study followed qualitative descriptive methodology and used the Consolidated Framework for Implementation Research (CFIR) to guide the research. Interviews were conducted with clinicians working in an inpatient addictions service at a large mental health and addictions teaching hospital in Toronto, Canada. Data analysis was performed using directed content analysis and the CFIR domains. RESULTS Twelve clinicians participated in semi-structured interviews. Participants included prescribers (such as physicians and nurse practitioners), registered nurses, allied health clinicians, and leadership. Participants had positive attitudes toward the patient portal, believing it would benefit patients and support consistency in healthcare. However, they also expressed reservations about its relevance and value during short inpatient admissions. Clinicians perceived the patient portal as compatible with existing workflows, enhancing patient empowerment and facilitating access to medical documentation. Concerns were raised about potential negative impacts on therapeutic rapport, particularly if patients disagreed with or were upset by the contents of their notes. Adaptations to the portal, such as improving documentation templates and providing detailed medication information, were suggested. Participants also highlighted advantages of the portal, including secure communication and access to laboratory results. CONCLUSIONS Clinicians generally had positive attitudes toward implementing a patient portal. However, concerns about maintaining therapeutic rapport and the relevance of information to patients were identified, and adaptations were suggested to improve the utility of a portal in the context of short inpatient stays. The findings provide insights into clinician perspectives and can inform the implementation of patient portals in inpatient addiction settings.
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Affiliation(s)
- Sara Ling
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada.
| | - Iman Kassam
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Shaista Haider
- Acute Care Progam, Centre for Addiction and Mental Health, Toronto, Canada
| | - Brian Lo
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Gillian Strudwick
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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