Preparing Patients and Clinicians for Open Notes in Mental Health: Qualitative Inquiry of International Experts

Charlotte Blease; John Torous; Anna Kharko; Catherine M DesRoches; Kendall Harcourt; Stephen O'Neill; Liz Salmi; Deborah Wachenheim; Maria Hägglund

doi:10.2196/27397

Preparing Patients and Clinicians for Open Notes in Mental Health: Qualitative Inquiry of International Experts

JMIR Ment Health. 2021 Apr 16;8(4):e27397. doi: 10.2196/27397.

Authors

Charlotte Blease¹, John Torous², Anna Kharko³, Catherine M DesRoches^{1

4}, Kendall Harcourt¹, Stephen O'Neill¹, Liz Salmi¹, Deborah Wachenheim¹, Maria Hägglund⁵

Affiliations

¹ Division of General Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.
² Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, United States.
³ School of Psychology, University of Plymouth, Plymouth, United Kingdom.
⁴ Department of Psychiatry, Harvard Medical School, Boston, MA, United States.
⁵ Department of Women's and Children's Health, University of Uppsala, Uppsala, Sweden.

PMID: 33861202
PMCID: PMC8087962
DOI: 10.2196/27397

Abstract

Background: In a growing number of countries worldwide, clinicians are sharing mental health notes, including psychiatry and psychotherapy notes, with patients.

Objective: The aim of this study is to solicit the views of experts on provider policies and patient and clinician training or guidance in relation to open notes in mental health care.

Methods: In August 2020, we conducted a web-based survey of international experts on the practice of sharing mental health notes. Experts were identified as informaticians, clinicians, chief medical information officers, patients, and patient advocates who have extensive research knowledge about or experience of providing access to or having access to mental health notes. This study undertook a qualitative descriptive analysis of experts' written responses and opinions (comments) to open-ended questions on training clinicians, patient guidance, and suggested policy regulations.

Results: A total of 70 of 92 (76%) experts from 6 countries responded. We identified four major themes related to opening mental health notes to patients: the need for clarity about provider policies on exemptions, providing patients with basic information about open notes, clinician training in writing mental health notes, and managing patient-clinician disagreement about mental health notes.

Conclusions: This study provides timely information on policy and training recommendations derived from a wide range of international experts on how to prepare clinicians and patients for open notes in mental health. The results of this study point to the need for further refinement of exemption policies in relation to sharing mental health notes, guidance for patients, and curricular changes for students and clinicians as well as improvements aimed at enhancing patient and clinician-friendly portal design.

Keywords: attitudes; electronic health records; mental health; mobile phone; open notes; psychiatry; psychotherapy; qualitative research; survey.

©Charlotte Blease, John Torous, Anna Kharko, Catherine M DesRoches, Kendall Harcourt, Stephen O'Neill, Liz Salmi, Deborah Wachenheim, Maria Hägglund. Originally published in JMIR Mental Health (http://mental.jmir.org), 16.04.2021.