Patients’ Positive and Negative Responses to Reading Mental Health Clinical Notes Online

Denneson, Lauren M.; Chen, Jason I.; Pisciotta, Maura; Tuepker, Anaïs; Dobscha, Steven K.

doi:10.1176/appi.ps.201700353

Cited by 43 publications

(52 citation statements)

References 11 publications

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“…Notably, a diagnosis of a psychotic, bipolar, or a personality disorder demonstrated no significant association with a negative emotional response to OpenNotes. 55,59 In March 2014, Beth Israel Deaconess Medical Center in Boston, United States, also began sharing behavioral health notes with 360 patients, publishing the organization's belief that doing so could benefit those with a spectrum of disorders as well as meaningfully influence the way clinicians frame their own thinking about their patients. 60 Since then, almost 60 organizations throughout the United States and Canada have started sharing behavioral health notes with patients.…”

Section: Clinicians' Perspectives On Opennotesmentioning

confidence: 99%

“…[49][50][51]55 • Pay close attention to potential reactions of stress or anxiety in response to note content, particularly in patients with PTSD. 59 • Where appropriate, use note content as a means of psychoeducation, explaining technical verbiage or content in lay terms. • Avoid labels that may be perceived as judgmental and instead use language that highlights the patient's individuality and strengths.…”

Section: Recommendations For Research and Practicementioning

confidence: 99%

See 1 more Smart Citation

Patients as Agents in Behavioral Health Research and Service Provision: Recommendations to Support the Learning Health System

Galvin¹,

Petersen

Subbian

et al. 2019

Appl Clin Inform

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Authentic inclusion and engagement of behavioral health patients in their care delivery and in the process of scientific discovery are often challenged in the health care system. Consequently, there is a growing need to engage with and better serve the needs of behavioral health patients, particularly by leveraging health information technologies. In this work, we present rationale and strategies for improving patient engagement in this population in research and clinical care. First, we describe the potential for creating meaningful patient–investigator partnerships in behavioral health research to allow for cocreation of knowledge with patients. Second, in the context of behavioral health services, we explore the utility of sharing clinical notes to promote patients' agency in care delivery. Both lines of inquiry are centered in a Learning Health System model for behavioral health, where patients are agents in enhancing the therapeutic alliance and advancing the process of knowledge generation. Recommendations include genuinely democratizing the health care system and biomedical research enterprise through patient-centered information technologies such as patient portals. In research and technology development, we recommend seeking and tailoring behavioral health patients' involvement to their abilities, promoting patient input in data analysis plans, evaluating research and informatics initiatives for patients and clinicians, and sharing success and research findings with patients. In clinical practice, we recommend encouraging patients to read behavioral health notes on portals, engaging in proactive communication regarding note content, assessing outcomes including stress and anxiety in response to note content, and working with technology providers to support note-sharing governance and deployment.

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Section: Clinicians' Perspectives On Opennotesmentioning

confidence: 99%

Section: Recommendations For Research and Practicementioning

confidence: 99%

Patients as Agents in Behavioral Health Research and Service Provision: Recommendations to Support the Learning Health System

Galvin¹,

Petersen

Subbian

et al. 2019

Appl Clin Inform

View full text Add to dashboard Cite

show abstract

“…This movement is supported by our and others' prior research with patients receiving mental health care, which has shown that reading progress notes often helps patients feel more in control of their health care, better able to understand their mental health and general medical conditions, and better able to remember their plan of care and to have more trust in clinicians. In contrast, relatively few patients have reported frequently feeling distress or worry after reading their notes (16,17).…”

Section: Discussionmentioning

confidence: 99%

Impacts of a Web-Based Course on Mental Health Clinicians’ Attitudes and Communication Behaviors Related to Use of OpenNotes

Dobscha

Kenyon

Pisciotta

et al. 2019

Self Cite

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The OpenNotes initiative encourages health care systems to provide patients online access to clinical notes. Some individuals have expressed concerns about use of OpenNotes in mental health care. This study evaluated changes in mental health clinicians' attitudes and communications with patients after participation in a Web-based course designed to reduce potential for unintended consequences and enhance likelihood of positive outcomes of OpenNotes.Methods: All 251 mental health clinicians (physicians, nurse practitioners, psychologists, and social workers) of a large U.S. Department of Veterans Affairs facility were invited to participate. Clinicians completed surveys at baseline and 3 months after course participation. Ten items were examined that addressed clinicians' concerns and communication behaviors with patients. Mixed-effects models with repeated measures were used to compare pre-post data.Results: Of the 251 clinicians, 141 (56%) completed baseline surveys, and 113 (80%) completed baseline and postcourse surveys. Of the 141 clinicians, 63% were female, 46% were social workers, 34% were psychologists, 16% were psychiatrists, and 4% were nurse practitioners. In final adjusted models, pre-post item scores indicated significant increases in clinicians' ability to communicate with and educate patients (p,.01) and in the frequency with which clinicians educated patients about OpenNotes access (p,.001), advised patients to access and read notes (p,.01), and asked patients about questions or concerns they have with notes (p=.04). There was also a significant reduction in clinicians' worry about negative consequences (p=.05). Conclusions:A Web-based course for mental health clinicians on use of OpenNotes resulted in self-reported improvements in some concerns and in aspects of patientclinician communication.

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“…Patients reported that the medical notes eased their uncertainty, relieved anxiety, and facilitated control [74]. Denneson et al [75] found that reading OpenNotes helped 49% of patients have feelings ranging from very to extremely in control of their health care. Another study observed that access to notes increased patient trust toward their health care providers [92].…”

Section: Medical Notesmentioning

confidence: 99%

“…For subsets of patients, access to medical notes increased their anxiety levels [74]. One study found that 26% of the patents experienced stress or worry sometimes, whereas 8% reported often or always [75]. The study also reported that 18% of patients felt upset sometimes after reading their notes, compared with 8% who reported often or always.…”

Section: Medical Notesmentioning

confidence: 99%

Capturing the Impact of Patient Portals Based on the Quadruple Aim and Benefits Evaluation Frameworks: Scoping Review (Preprint)

Avdagovska¹,

Menon²,

Stafinski³

2020

Preprint

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BACKGROUND Electronic patient portals are secure websites tied to an institutional electronic health record system from which patients can view their medical information. These types of records are populated with a person’s lifetime health history. Despite the continuing extensive research in this area, measuring patient portal impact continues to be a convoluted process. OBJECTIVE To explore what is known about patient portal evaluations and provide recommendations for future endeavours. The focus was on mapping what measures are used to assess the impact of patient portals on the four specific dimensions (patient, population, healthcare workforce, and health system perspectives) of the Quadruple Aim Framework, and what components from the Benefits Evaluation Framework were most commonly evaluated to measure impact. METHODS A scoping review was conducted using the methodological framework of Arksey and O’Malley. Reporting was guided by Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. A systematic and comprehensive search using the OVID platform, the following databases were searched: Ovid MEDLINE® ALL, including Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Embase, and PsycINFO. CINAHL on the Ebsco platform and Web of Science were also searched for studies published between 2015 and June 2020. A systematic grey literature search was conducted using the Google search engine in Edmonton, Alberta, Canada between February 13 and February 25, 2020. A data extraction form was developed and reviewed to categorize the literature into themes and areas of interest, which varied by study type. Two frameworks for analysis were incorporated, the Quadruple Aim and the Canada Health Infoway’s Benefits Evaluation Frameworks. Extracted data were tabulated based on a coding template developed to categorize the literature into themes and areas of interest, which varied by study type and QA perspective. Furthermore, the evaluated patient portal functions were mapped onto the Benefits Evaluation Framework. A descriptive, analytical approach was used to summarize the outcomes of the studies. In addition, a list of the various terms/outcomes/variables that were used to describe ‘impact’ was compiled. RESULTS In total, 96 studies were included for data extraction. The studies were categorized based on the Quadruple Aim dimensions, with strict adherence to the definitions for each dimension(1,2). From the patient perspective, we identified that most evaluations focused on benefits and barriers to access, access to test results, medication adherence, condition management, medical notes, and secure messaging. From the population perspective, the evaluations focused on increase in population outreach, decrease in disparities related to access of care services, and improvement in quality of care. From the healthcare workforce perspective, the evaluations focused on impact of patients accessing medical records, impact on workflow, impact of bi-directional secure messaging, and virtual care. From the health system perspective, the evaluations focused on decrease in no-show appointments, impact on office visits and telephone calls, impact on admission and readmission rates and emergency department visits, and impact on healthcare utilization. Altogether, 77 peer-reviewed studies were mapped on the expanded version of the BE Framework. The mapping was done by sub-dimension to create a more precise representation about the areas that are currently explored when studying patient portals. Most of the studies evaluated more than one sub-dimension. CONCLUSIONS Despite the extensive and existing research in the area of patient portals, the evidence from this scoping review suggests that impact research is available, but it lacks multidimensionality. The Quadruple Aim and the Benefits Evaluation Frameworks provided guidance in identifying the gaps in the current literature by providing a way to show how impact was assessed. This review highlights the need to appropriately plan how impact will be assessed and how the findings will be translated into effective adaptations. If the how and what are not properly planned, the generalizability of patient portals studies will continue to elude researchers and implementation teams.

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Patients’ Positive and Negative Responses to Reading Mental Health Clinical Notes Online

Abstract: Patients receiving mental health care frequently reported benefits from reading OpenNotes, yet some experienced negative responses.

Cited by 43 publications

References 11 publications

Patients as Agents in Behavioral Health Research and Service Provision: Recommendations to Support the Learning Health System

Patients as Agents in Behavioral Health Research and Service Provision: Recommendations to Support the Learning Health System

Impacts of a Web-Based Course on Mental Health Clinicians’ Attitudes and Communication Behaviors Related to Use of OpenNotes

Capturing the Impact of Patient Portals Based on the Quadruple Aim and Benefits Evaluation Frameworks: Scoping Review (Preprint)

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