Norwegian Centre for E-Health Research, University Hospital of North Norway, Tromsø, Norway.
Department of Clinical Medicine, UiT The Arctic University of Norway, Tromsø, Norway.
BMC Psychiatry. 2022 Jul 28;22(1):508. doi: 10.1186/s12888-022-04123-7.
Patient accessible electronic health records (PAEHR) hold the potential to increase patient empowerment, especially for patients with complex, long-term or chronic conditions. However, evidence of its benefits for patients who undergo mental health treatment is unclear and inconsistent, and several concerns towards use of PAEHR emerged among health professionals. This study aimed at exploring the impact of PAEHR among mental health professionals in terms of patient-provider relationship, changes in the way of writing in the electronic health records and reasons for denying access to information.
In-depth qualitative interviews with health professionals working in two mental health outpatient clinics at Helgelandssykehuset in Northern Norway, one of the first hospitals in Norway to implement the PAEHR in 2015. The interviews were conducted by phone or videoconferencing, audio recorded and transcribed verbatim. Data were analyzed by a multidisciplinary research team using the Framework Method.
A total of 16 in-depth qualitative interviews were conducted in April and May 2020. The PAEHR implemented in Norway was seen as a tool to increase transparency and improve the patient-provider relationship. The PAEHR was seen to have negative consequences only in limited situations, such as for patients with severe mental conditions, for child protective services when parents access their children's journal, or for patients with abusive partners. The functionality to deny access to the journal was used rarely. A more common practice for making information not immediately available was to delay the final approval of the notes. The documentation practices changed over the years, but it was not clear to what extent the changes were attributable to the introduction of the PAEHR. Health professionals write their notes keeping in mind that patients might read them, and they try to avoid unclear language, information about third parties, and hypotheses that might create confusion.
The concerns voiced by mental health professionals regarding the impact of the PAEHR on the patient-provider relationship and practices to deny access to information were not supported by the results of this study. Future research should explore changes in documentation practices by analysing the content of the electronic health records.
患者可访问的电子健康记录 (PAEHR) 有可能增强患者的自主权，尤其对于患有复杂、长期或慢性疾病的患者。然而，PAEHR 对接受心理健康治疗的患者的益处的证据尚不清楚且不一致，并且卫生专业人员对使用 PAEHR 提出了一些担忧。本研究旨在探讨 PAEHR 对心理健康专业人员在医患关系、电子健康记录书写方式的变化以及拒绝获取信息的原因方面的影响。
对 2015 年在挪威北部海格兰德郡医院 (Helgelandssykehuset) 的两家精神科门诊工作的卫生专业人员进行了深入的定性访谈，该医院是挪威首批实施 PAEHR 的医院之一。访谈通过电话或视频会议进行，录音并逐字转录。研究团队采用多学科研究方法使用框架方法进行数据分析。
2020 年 4 月和 5 月共进行了 16 次深入的定性访谈。挪威实施的 PAEHR 被视为提高透明度和改善医患关系的工具。只有在有限的情况下，PAEHR 才会产生负面影响，例如对于患有严重精神疾病的患者、儿童保护服务机构在父母访问其子女日记时、或对于有虐待伴侣的患者。很少使用拒绝访问日记的功能。更常见的做法是延迟最后批准记录，从而使信息无法立即获得。多年来，文档编写实践发生了变化，但尚不清楚这些变化在多大程度上归因于 PAEHR 的引入。卫生专业人员在编写记录时牢记患者可能会阅读这些记录，并且尽量避免使用不明确的语言、第三方信息和可能引起混淆的假设。
本研究结果并未证实心理健康专业人员对 PAEHR 对医患关系和拒绝获取信息的做法的影响表示的担忧。未来的研究应该通过分析电子健康记录的内容来探索文档编写实践的变化。
