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Survey of Mental Health Clinician Experiences and Attitudes toward OpenNotes

Dobscha SK, Denneson LM, Jacobson LE, Williams HB, Woods SS. Survey of Mental Health Clinician Experiences and Attitudes toward OpenNotes. Paper presented at: AcademyHealth Annual Research Meeting; 2015 Jun 14; Minneapolis, MN.




Abstract:

Research Objective: Recently, patient access to reading clinical progress notes online (Open Notes) has become available in some larger health systems. Since January 2013, patients authenticated to use My HealtheVet, the Department of Veterans Affairs (VA)'s personal health record, have been able to access all of their clinical notes (including mental health notes) using the "Blue Button" feature. However, some members of the medical community have raised concerns that access to progress notes may cause some patients to experience anxiety, confusion, or offense; mental health is a special area of concern due to the sensitive nature of information that may be documented. To date, no studies have examined potential benefits or harms of Open Notes in mental health care as perceived by mental health clinicians. The main objective of this study was to describe mental health clinician experiences with, and attitudes toward, Open Notes use by patients receiving mental health care in the VA. Study Design: Cross-sectional 35-item survey conducted in Fall 2014. Survey items were adapted with permission from Delbanco et al (2012). Survey data were collected over 6-weeks, and managed using Research Electronic Data Capture (REDCap), an electronic data capture tool hosted within the Veterans Affairs Informatics and Computer Infrastructure. Population Studied: Mental health clinicians and nurses from the mental health division of a single VA Medical Center. Principal Findings: Two-hundred-eight of 263 (79%) of potentially eligible subjects participated in the survey; the proportions of clinicians from various disciplines represented were similar when comparing survey respondents to the overall group eligible for participation. The majority (85%) of respondents agreed or somewhat agreed that making medical record notes available to patients is a good idea in general, but only 54% agreed that making mental health notes available is a good idea. Sixty-seven percent of respondents believed that their patients will better remember the plan of care, but 77% felt that patients will worry more, and 76% felt that patients will request changes in their notes. Thirty-five percent of respondents felt there will be impacts on safety, and 88% believed that Open Notes will have discernable impacts on their practices, with 69% reporting being less detailed in their documentation due to Open Notes. Thirteen percent of respondents reported having conversations with Veterans about their notes one or more times per month. Forty-nine percent of participants reported that they would be somewhat to very pleased if mental health Open Notes was discontinued. Conclusions: While positive about Open Notes in general, mental health clinicians and nurses are more ambivalent about their use in mental health, recognizing some potential benefits, but expressing concerns about several potential negative impacts on patients and their practices. Implications for Policy or Practice: The results call for further research to improve our understanding of actual outcomes related to Open Notes use in mental health, as well as the development of educational programs or other supports to assist mental health clinicians and nurses in minimizing unintended consequences and optimizing potential benefits associated with Open Notes.





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