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

Abstract

Journal of Medical Internet Research - International Scientific Journal for Medical Research, Information and Communication on the Internet #Preprint #PeerReviewMe: Warning: This is a unreviewed preprint. Readers are warned that the document has not been peer-reviewed by expert/patient reviewers or an academic editor, may contain misleading claims, and is likely to undergo changes before final publication, if accepted, or may have been rejected/withdrawn. Readers with interest and expertise are encouraged to sign up as peer-reviewer, if the paper is within an open peer-review period. Please cite this preprint only for review purposes or for grant applications and CVs (if you are the author). Background: A growing number of countries worldwide are sharing mental health notes, including psychiatry and psychotherapy notes, with patients. Objective: To solicit the views of experts on 1) provider policies and 2) patient and clinician training/guidance in relation to open notes in mental healthcare. Methods: In September 2020, we conducted an online 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, and/or experience of providing access to or having access to, mental health notes. The present study undertook qualitative descriptive analysis of experts’ written responses and opinions (“comments”) to open-ended questions on: (1) training clinicians; (2) patient guidance; and (3) suggested policy regulations. Results: A total of 70 of 92 (76%) of experts from six countries responded. We identified four major themes related to opening mental health notes to patients: (1) the need for clarity about provider policies on exemptions; (2) providing patients with basic information about open notes; (3) clinician training in writing mental health notes; and (4) managing patient-clinician disagreement about mental health notes. Conclusions: This study presents 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.