Denneson Lauren M, Cromer Risa, Williams Holly B, Pisciotta Maura, Dobscha Steven K
VA Portland Health Care System, Center to Improve Veteran Involvement in Care (CIVIC), Portland, OR, United States.
Oregon Health & Science University, Department of Psychiatry, Portland, OR, United States.
J Med Internet Res. 2017 Jun 14;19(6):e208. doi: 10.2196/jmir.6915.
As part of the national OpenNotes initiative, the Veterans Health Administration (VHA) provides veterans online access to their clinical progress notes, raising concern in mental health settings.
The aim of this study was to examine the perspectives and experiences of mental health clinicians with OpenNotes to better understand how OpenNotes may be affecting mental health care.
We conducted individual semi-structured interviews with 28 VHA mental health clinicians and nurses. Transcripts were analyzed using a thematic analysis approach, which allows for both inductive and deductive themes to be explored using an iterative, constant comparative coding process.
OpenNotes is changing VHA mental health care in ways that mental health clinicians perceive as both challenging and beneficial. At the heart of these changes is a shifting power distribution within the patient-clinician relationship. Some clinicians view OpenNotes as an opportunity to better partner with patients, whereas others feel that it has the potential to undo the therapeutic relationship. Many clinicians are uncomfortable with OpenNotes, but acknowledge that this discomfort could both improve and diminish care and documentation practices. Specifically, we found that (1) OpenNotes is empowering patients, (2) OpenNotes is affecting how clinicians build and maintain the therapeutic relationship, and (3) mental health clinicians are adjusting their practices to protect patients and themselves from adverse consequences of OpenNotes.
Our findings suggest that future research should monitor whether OpenNotes notes facilitates stronger patient-clinician relationships, enhancing patient-centered mental health care, or diminishes the quality of mental health care through disruptions in the therapeutic relationship and reduced documentation.
作为全国“开放病历”倡议的一部分，退伍军人健康管理局（VHA）为退伍军人提供在线访问其临床病程记录的权限，这在心理健康领域引发了担忧。
本研究旨在探讨心理健康临床医生对“开放病历”的看法和体验，以更好地理解“开放病历”可能如何影响心理健康护理。
我们对28名VHA心理健康临床医生和护士进行了个人半结构化访谈。使用主题分析方法对访谈记录进行分析，该方法允许通过迭代的、持续比较编码过程探索归纳和演绎主题。
“开放病历”正在以心理健康临床医生认为既具有挑战性又有益的方式改变VHA的心理健康护理。这些变化的核心是患者与临床医生关系中权力分配的转变。一些临床医生将“开放病历”视为与患者更好合作的机会，而另一些人则认为它有可能破坏治疗关系。许多临床医生对“开放病历”感到不安，但承认这种不安可能会改善也可能会削弱护理和记录做法。具体而言，我们发现：（1）“开放病历”正在赋予患者权力；（2）“开放病历”正在影响临床医生建立和维持治疗关系的方式；（3）心理健康临床医生正在调整他们的做法，以保护患者和他们自己免受“开放病历”的不良后果影响。
我们的研究结果表明，未来的研究应监测“开放病历”是否有助于建立更牢固的患者与临床医生关系，加强以患者为中心的心理健康护理，还是会通过破坏治疗关系和减少记录来降低心理健康护理质量。
