Division of General Medicine, Beth Israel Deaconess Medical Center.
Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
J Nerv Ment Dis. 2021 Apr 1;209(4):265-269. doi: 10.1097/NMD.0000000000001303.
In the last decade, many health organizations have embarked on a revolution in clinical communication. Using electronic devices, patients can now gain rapid access to their online clinical records. Legally, patients in many countries already have the right to obtain copies of their health records; however, the practice known as "open notes" is different. Via secure online health portals, patients are now able to access their test results, lists of medications, and the very words that clinicians write about them. Open notes are growing with most patients in the Nordic countries already offered access to their full electronic record. From April 2021, a new federal ruling in the United States mandates-with few exemptions-that providers offer patients access to their online notes (Office of the National Coordinator for Health Information Technology, Department of Health and Human Services, Available at: https://www.govinfo.gov/content/pkg/FR-2019-03-04/pdf/2019-02224.pdf#page=99). Against these policy changes, only limited attention has been paid to the ethical question about whether patients with mental health conditions should access their notes, as mentioned in the articles by Strudwick, Yeung, and Gratzer (Front Psychiatry 10:917, 2019) and Blease, O'Neill, Walker, Hägglund, and Torous (Lancet Psychiatry 7:924-925, 2020). In this article, our goal is to motivate further inquiry into opening mental health notes to patients, particularly among persons with serious mental illness and those accessing psychological treatments. Using biomedical ethical principles to frame our discussion, we identify key empirical questions that must be pursued to inform ethical practice guidelines.
在过去的十年中，许多卫生组织在临床沟通方面进行了一场革命。通过电子设备，患者现在可以快速访问他们的在线临床记录。在许多国家，法律上患者已经有权获得他们的健康记录副本；然而，“开放病历”的做法有所不同。通过安全的在线健康门户，患者现在可以访问他们的测试结果、药物清单，以及临床医生记录的他们的病情。开放病历的做法正在北欧国家普及，大多数患者已经可以访问他们的完整电子病历。自 2021 年 4 月起，美国的一项新联邦裁决规定——除了少数例外——提供者必须为患者提供在线病历的访问权限（国家卫生信息技术协调员办公室，卫生与公众服务部，可在：https://www.govinfo.gov/content/pkg/FR-2019-03-04/pdf/2019-02224.pdf#page=99）。尽管政策发生了这些变化，但只有有限的注意力集中在关于心理健康状况的患者是否应该访问他们的病历这一伦理问题上，正如 Strudwick、Yeung 和 Gratzer（《精神病前沿》10：917，2019 年）以及 Blease、O'Neill、Walker、Hägglund 和 Torous（《柳叶刀精神病学》7：924-925，2020 年）的文章中所提到的那样。在本文中，我们的目标是进一步探讨向患者开放心理健康病历的问题，特别是针对患有严重精神疾病和接受心理治疗的患者。我们使用生物医学伦理原则来构建我们的讨论，确定必须进行的关键实证问题，以便为道德实践指南提供信息。
