Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Nov 29, 2023
Date Accepted: Nov 25, 2024
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Impact of Patient Accessible Electronic Health Records on Information Practices in Mental Healthcare Contexts: A Scoping Review
ABSTRACT
Background:
Giving patients electronic access to their health records is a goal of many healthcare systems. 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 how healthcare professionals (HCPs) and patients document, share, and utilize information in services with a patient accessible electronic health record (PAEHR). This review frames these information activities as information practices to capture how they are situated and shaped by factors specific to the mental healthcare context. In doing so, this review explores how the unique context of mental healthcare shapes the interactions between HCPs, patients and PAEHRs and the resultant information practices.
Objective:
We undertook a scoping review to explore the impact of PAEHRs on the information practices of healthcare professionals and patients in mental healthcare contexts.
Methods:
A scoping review was considered the most appropriate method for this review due to the relatively recent adoption of PAEHRs in mental healthcare contexts. A comprehensive search of electronic databases was conducted for articles 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 were documented, and a thematic synthesis approach was taken to develop themes that addressed the research questions.
Results:
The final review included 66 articles. The included studies were highly heterogeneous, with various study designs and objectives. The impacts 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 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 of service-level guidelines on how to utilize PAEHRs, and (3) they may contribute towards improved communication between HCPs and patients, including constructive disagreements regarding what was documented. Further, PAEHRs supported new information practices for patients that could contribute to person-centered care and self-management, such as being utilized to prepare for clinical encounters.
Conclusions:
We have identified several ways in which PAEHRs are shaping the information practices of healthcare professionals and patients. 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.
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