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Publication Briefs

Web-Based Program Helps Empower Veterans Who Read their Mental Health Notes Online to Actively Participate in Care

In accordance with the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009, the VA OpenNotes initiative has expanded patient access to health information; VA now allows patients to access their electronic health record progress notes online. Research suggests that reading notes may increase patients' engagement and help them feel more in control of their health care, but some clinicians worry that it may also upset Veterans and strain patient-clinician therapeutic rapport. To reduce unintended harms and increase benefits, investigators developed a web-based educational program with the goal of increasing Veterans' understanding of their mental health notes and providing guidance on communicating with clinicians about notes. This study sought to evaluate whether the program improved patient-clinician communication and increased patient engagement in their care. Between February and July 2016, investigators collected baseline and post-training assessments from 247 Veterans at one large medical center. Data were collected on healthcare use and mental health diagnoses as well as patient engagement in care and patient perceptions of the patient-clinician relationship.


  • Overall, improvements were observed post-training in patient activation, perceived efficacy in healthcare interactions, and trust in their physician.
  • In fully adjusted models, patient activation and perceived efficacy increased significantly between pre- and post-training assessments, but improvements in trust were no longer significant.
  • Older age and higher baseline e-health literacy levels were associated with higher patient activation, a stronger therapeutic relationship, and higher perceived efficacy in healthcare interactions.
  • Recent schizophrenia/bipolar disorder diagnosis was associated with higher patient activation and higher perceived efficacy in healthcare relations.


  • This web-based educational program may help Veterans who read their mental health notes feel more empowered in their healthcare and improve perceptions of their clinician relationships.


  • Findings may not be generalizable to all Veterans since this study's population was derived from only one VA medical center.
  • Veterans who wished to be more engaged in their care may have been more likely to participate, introducing some selection bias.

This study was funded by HSR&D (IIR 13-347). All authors are part of HSR&D's Center to Improve Veteran Involvement in Care (CIVIC), Portland, OR.

PubMed Logo Denneson L, Pisciotta M, Hooker E, Trevino A, and Dobscha S. Impacts of a Web-Based Educational Program for Veterans Who Read Their Mental Health Notes Online. Journal of the American Medical Informatics Association. January 1, 2019;26(1):3-8.

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HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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