1.
Blease, Charlotte, et al.
(författare)
Does Patient Access to Clinical Notes Change Documentation?
2020
Ingår i: Frontiers In Public Health. - : Frontiers Media SA. - 2296-2565. ; 8
Tidskriftsartikel (refereegranskat) abstract
Open, honest, and trustworthy communication is crucial to ensure the effective responses of citizens. Paralleling transparency in the arena of public health are new practice policies that are set to transform the transmission of information at the level of doctors and patients. While patients have legally been entitled to obtain copies of their records for many years, in March 2020 federal legislation in the United States (U.S.) mandated that health providers offer all patients rapid and secure online access to their clinical notes via patient portals (“open notes”) (1). Similar developments are underway in the United Kingdom (U.K.) where in April 2020 it was announced that patients in NHS England will be granted online access, albeit prospectively, to their full general practitioners' notes (2). Worldwide, open notes have already been enacted in more than ten countries including Sweden, Estonia, and Norway (3).A variety of surveys have been conducted into patients' and doctors' experiences of open notes but much less is understood about the objective changes in documentation that may arise as a result of patient access (4–7). We review current research into open notes including clinicians' reports on how they have modified their notes as a result of implementing the practice. Highlighting the potentially beneficial and harmful effects that different types of documentation changes might have on the therapeutic relationship and on patient outcomes, we argue that more research is needed to investigate objective changes in notes as a result of patient access.
2.
Blease, Charlotte, et al.
(författare)
Generative Language Models and Open Notes : Exploring the Promise and Limitations
2024
Ingår i: JMIR Med Educ. - : JMIR Publications. - 2369-3762. ; 10
Tidskriftsartikel (refereegranskat) abstract
Patients’ online record access (ORA) is growing worldwide. In some countries, including the United States and Sweden, access is advanced with patients obtaining rapid access to their full records on the web including laboratory and test results, lists of prescribed medications, vaccinations, and even the very narrative reports written by clinicians (the latter, commonly referred to as “open notes”). In the United States, patient’s ORA is also available in a downloadable form for use with other apps. While survey studies have shown that some patients report many benefits from ORA, there remain challenges with implementation around writing clinical documentation that patients may now read. With ORA, the functionality of the record is evolving; it is no longer only an aide memoire for doctors but also a communication tool for patients. Studies suggest that clinicians are changing how they write documentation, inviting worries about accuracy and completeness. Other concerns include work burdens; while few objective studies have examined the impact of ORA on workload, some research suggests that clinicians are spending more time writing notes and answering queries related to patients’ records. Aimed at addressing some of these concerns, clinician and patient education strategies have been proposed. In this viewpoint paper, we explore these approaches and suggest another longer-term strategy: the use of generative artificial intelligence (AI) to support clinicians in documenting narrative summaries that patients will find easier to understand. Applied to narrative clinical documentation, we suggest that such approaches may significantly help preserve the accuracy of notes, strengthen writing clarity and signals of empathy and patient-centered care, and serve as a buffer against documentation work burdens. However, we also consider the current risks associated with existing generative AI. We emphasize that for this innovation to play a key role in ORA, the cocreation of clinical notes will be imperative. We also caution that clinicians will need to be supported in how to work alongside generative AI to optimize its considerable potential.
3.
Blease, Charlotte, et al.
(författare)
Patients, clinicians and open notes : information blocking as a case of epistemic injustice
2022
Ingår i: Journal of Medical Ethics. - : BMJ Publishing Group Ltd. - 0306-6800 .- 1473-4257. ; 48:10, s. 785-793
Tidskriftsartikel (refereegranskat) abstract
In many countries, including patients are legally entitled to request copies of their clinical notes. However, this process remains time-consuming and burdensome, and it remains unclear how much of the medical record must be made available. Online access to notes offers a way to overcome these challenges and in around 10 countries worldwide, via secure web-based portals, many patients are now able to read at least some of the narrative reports written by clinicians (’open notes’). However, even in countries that have implemented the practice many clinicians have resisted the idea remaining doubtful of the value of opening notes, and anticipating patients will be confused or anxious by what they read. Against this scepticism, a growing body of qualitative and quantitative research reveals that patients derive multiple benefits from reading their notes. We address the contrasting perceptions of this practice innovation, and claim that the divergent views of patients and clinicians can be explained as a case of epistemic injustice. Using a range of evidence, we argue that patients are vulnerable to (oftentimes, non-intentional) epistemic injustice. Nonetheless, we conclude that the marginalisation of patients’ access to their health information exemplifies a form of epistemic exclusion, one with practical and ethical consequences including for patient safety.
4.
Blease, Charlotte, et al.
(författare)
Preparing Patients and Clinicians for Open Notes in Mental Health : Qualitative Inquiry of International Experts
2021
Ingår i: JMIR Mental Health. - : JMIR Publications. - 2368-7959. ; 8:4
Tidskriftsartikel (refereegranskat) 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.
5.
Blease, Charlotte R, et al.
(författare)
Sharing clinical notes, and placebo and nocebo effects : Can documentation affect patient health?
2022
Ingår i: Journal of Health Psychology. - : SAGE Publications. - 1359-1053 .- 1461-7277. ; 27:1, s. 135-146
Tidskriftsartikel (refereegranskat) abstract
This paper connects findings from the field of placebo studies with research into patients' interactions with their clinician's visit notes, housed in their electronic health records. We propose specific hypotheses about how features of clinicians' written notes might trigger mechanisms of placebo and nocebo effects to elicit positive or adverse health effects among patients. Bridging placebo studies with (a) survey data assaying patient and clinician experiences with portals and (b) randomized controlled trials provides preliminary support for our hypotheses. We conclude with actionable proposals for testing our understanding of the health effects of access to visit notes.
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7.
Bärkås, Annika, et al.
(författare)
Analysis of Voluntary User Feedback of the Swedish National PAEHR Service
2019
Ingår i: MEDINFO 2019. - : IOS Press. - 9781643680033 - 9781643680026 ; 264, s. 1126-1130
Konferensbidrag (refereegranskat) abstract
"Journalen" is a patient accessible electronic health record (PAEHR) and the national eHealth service for Sweden's citizens to gain access to their EHR. The Swedish national eHealth organization Inera, responsible for Journalen, created an inbox to receive voluntary user feedback about Journalen in order to improve the service from the user perspective. Based on voluntary user feedback via email. This study explored patients' experiences of using the national eHealth service and identified pros and cons. A mixed method content analysis was performed. In total, 1084 emails from 2016-2017 have been analyzed. 9 categories were identified, the most frequent ones related to questions about why some information was not accessible (due to regional differencies), feedback (including only positive or negative comments as well as constructive improvement suggestions), and emails about errors that user found in their record. These data can be successfully used to continuously improve an already implemented eHealth service.
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