VA mental health clinician experiences and attitudes toward OpenNotes

Dobscha, Steven K.; Denneson, Lauren M.; Jacobson, Laura; Williams, Holly B.; Cromer, Risa; Woods, Susan

doi:10.1016/j.genhosppsych.2015.08.001

Cited by 106 publications

(137 citation statements)

References 13 publications

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“…This concern could be viewed as stemming from clinicians feeling obligated to protect their patients in the more traditional, paternalistic style of care. In previous work, nearly two-third of VHA mental health clinicians surveyed stated that they had made changes in how they document as a result of OpenNotes, with the majority reporting that they write fewer details in the notes [14]. Together, this suggests that while OpenNotes may help to facilitate care that is more aligned with patient-centered care ideals, mental health clinicians are also often limiting what they write in response to a desire to protect themselves and their patients, which could have unintended negative consequences such as forcing clinicians to rely on their memory more often or reducing clinician-clinician collaboration.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, since mental health notes often contain sensitive information about patients’ mental illness, they have historically been treated differently from other progress notes, sometimes requiring clinician approval for patients to see or receive paper copies of their notes [13]. Despite promising findings from studies of primary care patients [9,10], some are concerned that this increased ease of access to mental health notes may cause unnecessary worry, confusion, or distress among patients who read their mental health progress notes without guidance or permission from their clinicians [14,15]. …”

Section: Introductionmentioning

confidence: 99%

“…In a brief survey of VHA mental health clinicians about OpenNotes, approximately half of clinicians did not feel that mental health OpenNotes was a good idea [14]. Although they thought some positive outcomes might come out of OpenNotes, most expressed concern over potential negative consequences from OpenNotes and reported making changes to their note writing practices, including writing fewer details, changing the tone of the note, and writing less information about diagnoses [14].…”

Section: Introductionmentioning

confidence: 99%

“…Although they thought some positive outcomes might come out of OpenNotes, most expressed concern over potential negative consequences from OpenNotes and reported making changes to their note writing practices, including writing fewer details, changing the tone of the note, and writing less information about diagnoses [14]. However, the impetus for such concern and documentation changes is poorly understood.…”

Section: Introductionmentioning

confidence: 99%

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A Qualitative Analysis of How Online Access to Mental Health Notes Is Changing Clinician Perceptions of Power and the Therapeutic Relationship

Denneson¹,

Cromer²,

Williams³

et al. 2017

J Med Internet Res

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BackgroundAs part of the national OpenNotes initiative, the Veterans Health Administration (VHA) provides veterans online access to their clinical progress notes, raising concern in mental health settings.ObjectiveThe aim of this study was to examine the perspectives and experiences of mental health clinicians with OpenNotes to better understand how OpenNotes may be affecting mental health care.MethodsWe conducted individual semi-structured interviews with 28 VHA mental health clinicians and nurses. Transcripts were analyzed using a thematic analysis approach, which allows for both inductive and deductive themes to be explored using an iterative, constant comparative coding process.ResultsOpenNotes is changing VHA mental health care in ways that mental health clinicians perceive as both challenging and beneficial. At the heart of these changes is a shifting power distribution within the patient-clinician relationship. Some clinicians view OpenNotes as an opportunity to better partner with patients, whereas others feel that it has the potential to undo the therapeutic relationship. Many clinicians are uncomfortable with OpenNotes, but acknowledge that this discomfort could both improve and diminish care and documentation practices. Specifically, we found that (1) OpenNotes is empowering patients, (2) OpenNotes is affecting how clinicians build and maintain the therapeutic relationship, and (3) mental health clinicians are adjusting their practices to protect patients and themselves from adverse consequences of OpenNotes.ConclusionsOur findings suggest that future research should monitor whether OpenNotes notes facilitates stronger patient-clinician relationships, enhancing patient-centered mental health care, or diminishes the quality of mental health care through disruptions in the therapeutic relationship and reduced documentation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A Qualitative Analysis of How Online Access to Mental Health Notes Is Changing Clinician Perceptions of Power and the Therapeutic Relationship

Denneson¹,

Cromer²,

Williams³

et al. 2017

J Med Internet Res

Self Cite

View full text Add to dashboard Cite

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“…Evidence indicates that such access improves communication and trust, patient safety, and potentially patient outcomes. [20][21][22][23][24] Two large integrated healthcare systems that launched tethered patient portals in 2003 with significant patient adoption and sustained use are Kaiser Permanente and the Department of Veterans Affairs (VA). Kaiser Permanente's (KP) portal, My Health Manager, is used by more than 5 million members, representing about 70% of adult KP members.…”

Section: Introductionmentioning

confidence: 99%

A Decade of Veteran Voices: Examining Patient Portal Enhancements Through the Lens of User-Centered Design (Preprint)

Nazi¹,

Turvey²,

Klein³

et al. 2018

Preprint

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Sharing Ethics Consultation Notes With Patients Through Online Portals

Mangino

Danis

2020

AMA Journal of Ethics

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Many health systems have adopted online patient portals that allow patients to easily view their health records. As a result, notes written by health care professionals are increasingly read by both clinicians and patients, and clinicians in specialties that routinely involve sensitive information (eg, mental health care) have had to construct notes in a manner that respectfully promotes therapeutic relationships with patients. This article discusses whether ethics consultation services should share notes with patients through online portals and ways to handle practical implementation challenges. In support of sharing notes, this article appeals to an existing right that patients have to access their health record and suggests that sharing ethics consultation notes might help patients understand key clinical ethics concepts and practices. To claim one AMA PRA Category 1 Credit TM for the CME activity associated with this article, you must do the following: (1) read this article in its entirety, (2) answer at least 80 percent of the quiz questions correctly, and (3) complete an evaluation. The quiz, evaluation, and form for claiming AMA PRA Category 1 Credit TM are available through the AMA Ed Hub TM .

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VA mental health clinician experiences and attitudes toward OpenNotes

Cited by 106 publications

References 13 publications

A Qualitative Analysis of How Online Access to Mental Health Notes Is Changing Clinician Perceptions of Power and the Therapeutic Relationship

A Qualitative Analysis of How Online Access to Mental Health Notes Is Changing Clinician Perceptions of Power and the Therapeutic Relationship

A Decade of Veteran Voices: Examining Patient Portal Enhancements Through the Lens of User-Centered Design (Preprint)

Sharing Ethics Consultation Notes With Patients Through Online Portals

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