JMIR Publications

ABSTRACT

Background:

Patients are increasingly being provided with access to their electronic health records. However, in mental healthcare contexts, concerns have been raised due to a perception that such access would pose risks to patients, third parties, and the therapeutic relationship. These perceived risks may affect the information activities of healthcare professionals (HCPs) and patients, such as how they document, share, and utilize information in mental healthcare services with a patient accessible electronic health record (PAEHR). This review frames these information activities as information practices to capture how the management of information is situated in and shaped by factors specific to the mental healthcare context. Though there is increasing research interest in PAEHRs, no study has focused specifically on the ways that they affect information practices. Understanding the impacts on information practices may help explain other outcomes of implementing PAEHRs and inform their design.

Objective:

We undertook a scoping review and narrative review to explore the research on PAEHRs in mental healthcare contexts, and how PAEHRs are affecting information practices of healthcare professionals and patients in this context.

Methods:

A combination of scoping review and narrative review was considered the most appropriate method due to the relatively recent adoption of PAEHRs in mental healthcare contexts, meaning the evidence base is quite heterogenous, including various research objectives and methodologies. A comprehensive search of electronic databases was conducted for original empirical studies that described the use of personal electronic health records, PAEHRs, Open Notes, patient portals, or associated systems in mental healthcare contexts. One author reviewed all full texts, with three other authors reviewing a selection of studies to cross-check the screening decisions. The study characteristics and findings were documented, and a thematic synthesis and textual narrative analysis was used to develop descriptive and analytical themes that addressed the research questions.

Results:

Sixty-six studies were considered eligible and included in the analysis. The impact of PAEHRs on information practices in mental healthcare contexts included (1) they may change how healthcare professionals document patient information, including a reduction in detail and a focus on information perceived by HCPs as objective rather than subjective, (2) they may negatively impact workflows; however, such concerns may be partly due to changes in documentation practices and a lack guidelines provided to HCPs on how to utilize PAEHRs, and (3) they may contribute towards improved communication between HCPs and patients, including constructive disagreements regarding what is documented in the health record. Underpinning the changes to HCP information practices, was consideration of the therapeutic relationship and patient safety. Furthermore, PAEHRs supported new information practices for patients, such as reading information in the PAEHR to prepare for clinical encounters.

Conclusions:

We have identified several ways in which PAEHRs are shaping the information practices of healthcare professionals and patients in the mental health context. These findings can inform the design of PAEHRs to promote information practices that contribute to improving the quality of mental healthcare. Further research is necessary to understand how changes in information practices due to the implementation of PAEHRs impact clinical outcomes and patient experiences of care.