Providing mental health care in the context of online mental health notes: advice from patients and mental health clinicians

Abstract

Background: The OpenNotes initiative provides patients online access to their clinical notes. Mental health clinicians in the Veterans Health Administration report a need for guidance on how to provide care, write notes, and discuss them in the context of OpenNotes.

Aim: To provide mental health clinicians recommendations identified by patients and clinicians that help them effectively practice in the context of OpenNotes.

Method: Twenty-eight mental health clinicians and 28 patients in mental health care participated in semi-structured interviews about their experiences and perceptions with OpenNotes. A rapid review approach was used to analyze transcripts.

Results: Analysis of interviews identified three domains of advice for mental health clinicians: writing notes that maintain the therapeutic relationship, communicating with patients about their notes and utilizing clinical notes as a patient resource to enhance care. Specific recommendations are provided.

Conclusion: Findings provide mental health clinicians with guidance from service users and clinicians on how to leverage clinical notes to maintain – and potentially enhance –therapeutic relationships in a healthcare system in which patients are able to read their mental health notes online.

Keywords:

• Health information technology
• mental health
• patient portal
• veterans

Acknowledgements

We gratefully acknowledge the Veteran consultants who provided feedback on this paper.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This material is based upon work supported by the Department of Veterans Affairs, Veterans Health Administration, and Health Services Research and Development Service Project [IIR 13-347]. The funders did not give input on study design; the collection, analysis or interpretation of data, the writing of the article; or the decision to submit it for publication. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or United States government.