The benefits and harms of open notes in mental health: A Delphi survey of international experts.
<h4>Importance</h4>As of April 5, 2021, as part of the 21st Century Cures Act, new federal rules in the U.S. mandate that providers offer patients access to their online clinical records.<h4>Objective</h4>To solicit the view of an international panel of experts on the effects...
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Public Library of Science (PLoS)
2021
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oai:doaj.org-article:8b6e4535d46a4414b72838b2280c34592021-12-02T20:16:59ZThe benefits and harms of open notes in mental health: A Delphi survey of international experts.1932-620310.1371/journal.pone.0258056https://doaj.org/article/8b6e4535d46a4414b72838b2280c34592021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0258056https://doaj.org/toc/1932-6203<h4>Importance</h4>As of April 5, 2021, as part of the 21st Century Cures Act, new federal rules in the U.S. mandate that providers offer patients access to their online clinical records.<h4>Objective</h4>To solicit the view of an international panel of experts on the effects on mental health patients, including possible benefits and harms, of accessing their clinical notes.<h4>Design</h4>An online 3-round Delphi poll.<h4>Setting</h4>Online.<h4>Participants</h4>International experts identified as clinicians, chief medical information officers, patient advocates, and informaticians with extensive experience and/or research knowledge about patient access to mental health notes.<h4>Main outcomes, and measures</h4>An expert-generated consensus on the benefits and risks of sharing mental health notes with patients.<h4>Results</h4>A total of 70 of 92 (76%) experts from 6 countries responded to Round 1. A qualitative review of responses yielded 88 distinct items: 42 potential benefits, and 48 potential harms. A total of 56 of 70 (80%) experts responded to Round 2, and 52 of 56 (93%) responded to Round 3. Consensus was reached on 65 of 88 (74%) of survey items. There was consensus that offering online access to mental health notes could enhance patients' understanding about their diagnosis, care plan, and rationale for treatments, and that access could enhance patient recall and sense of empowerment. Experts also agreed that blocking mental health notes could lead to greater harms including increased feelings of stigmatization. However, panelists predicted there could be an increase in patients demanding changes to their clinical notes, and that mental health clinicians would be less detailed/accurate in documentation.<h4>Conclusions and relevance</h4>This iterative process of survey responses and ratings yielded consensus that there would be multiple benefits and few harms to patients from accessing their mental health notes. Questions remain about the impact of open notes on professional autonomy, and further empirical work into this practice innovation is warranted.Charlotte BleaseAnna KharkoMaria HägglundStephen O'NeillDeborah WachenheimLiz SalmiKendall HarcourtCosima LocherCatherine M DesRochesJohn TorousPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 10, p e0258056 (2021) |
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Medicine R Science Q Charlotte Blease Anna Kharko Maria Hägglund Stephen O'Neill Deborah Wachenheim Liz Salmi Kendall Harcourt Cosima Locher Catherine M DesRoches John Torous The benefits and harms of open notes in mental health: A Delphi survey of international experts. |
| description |
<h4>Importance</h4>As of April 5, 2021, as part of the 21st Century Cures Act, new federal rules in the U.S. mandate that providers offer patients access to their online clinical records.<h4>Objective</h4>To solicit the view of an international panel of experts on the effects on mental health patients, including possible benefits and harms, of accessing their clinical notes.<h4>Design</h4>An online 3-round Delphi poll.<h4>Setting</h4>Online.<h4>Participants</h4>International experts identified as clinicians, chief medical information officers, patient advocates, and informaticians with extensive experience and/or research knowledge about patient access to mental health notes.<h4>Main outcomes, and measures</h4>An expert-generated consensus on the benefits and risks of sharing mental health notes with patients.<h4>Results</h4>A total of 70 of 92 (76%) experts from 6 countries responded to Round 1. A qualitative review of responses yielded 88 distinct items: 42 potential benefits, and 48 potential harms. A total of 56 of 70 (80%) experts responded to Round 2, and 52 of 56 (93%) responded to Round 3. Consensus was reached on 65 of 88 (74%) of survey items. There was consensus that offering online access to mental health notes could enhance patients' understanding about their diagnosis, care plan, and rationale for treatments, and that access could enhance patient recall and sense of empowerment. Experts also agreed that blocking mental health notes could lead to greater harms including increased feelings of stigmatization. However, panelists predicted there could be an increase in patients demanding changes to their clinical notes, and that mental health clinicians would be less detailed/accurate in documentation.<h4>Conclusions and relevance</h4>This iterative process of survey responses and ratings yielded consensus that there would be multiple benefits and few harms to patients from accessing their mental health notes. Questions remain about the impact of open notes on professional autonomy, and further empirical work into this practice innovation is warranted. |
| format |
article |
| author |
Charlotte Blease Anna Kharko Maria Hägglund Stephen O'Neill Deborah Wachenheim Liz Salmi Kendall Harcourt Cosima Locher Catherine M DesRoches John Torous |
| author_facet |
Charlotte Blease Anna Kharko Maria Hägglund Stephen O'Neill Deborah Wachenheim Liz Salmi Kendall Harcourt Cosima Locher Catherine M DesRoches John Torous |
| author_sort |
Charlotte Blease |
| title |
The benefits and harms of open notes in mental health: A Delphi survey of international experts. |
| title_short |
The benefits and harms of open notes in mental health: A Delphi survey of international experts. |
| title_full |
The benefits and harms of open notes in mental health: A Delphi survey of international experts. |
| title_fullStr |
The benefits and harms of open notes in mental health: A Delphi survey of international experts. |
| title_full_unstemmed |
The benefits and harms of open notes in mental health: A Delphi survey of international experts. |
| title_sort |
benefits and harms of open notes in mental health: a delphi survey of international experts. |
| publisher |
Public Library of Science (PLoS) |
| publishDate |
2021 |
| url |
https://doaj.org/article/8b6e4535d46a4414b72838b2280c3459 |
| work_keys_str_mv |
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