JMIR Publications

ABSTRACT

Background:

Patient access to their electronic health records (EHRs) could improve care and reduce errors by enabling patient contribution to documentation. However, interactive functions that support such engagement remain under-researched.

Objective:

The purpose of this study was to analyze patients’ use of a free-text comment function in the Swedish national patient-accessible EHR (PAEHR).

Methods:

Comments made by patients between 2015-2021 for healthcare professionals (HCPs) to view were retrieved from the PAEHR administration service in Sweden. Number and length of comments were analyzed using descriptive statistics and chi-square tests, while the content was examined qualitatively using inductive content analysis. In addition, comments were coded for sentiment (positive, neutral, or negative) and note content, and users were classified according to whether they had submitted at least one comment referring to mental healthcare.

Results:

1,670 comments were left by 659 patients, of which 15 had irrelevant content (0.9%, 95% CI 0.4%-1.4%), leaving 1,655 comments for analysis. A majority of comments (57.3%, 95% CI 54.9%-59.7%) were related to matters other than note content, most (920/1,655, 55.6%, 95% CI 53.2%-58.0%) had a neutral sentiment, and 42.4% (702/1,655, 95% CI 40.0%-44.8%) were negative. Patients who submitted a comment referencing mental healthcare tended to leave more comments overall (median 7 comments vs 2 per patient), and their comments were more frequently negative than comments written by other patients (63.2% vs 33.5%, p<.001). The most prevalent categories were care engagement, perceived inaccuracies, complaints, and requests.

Conclusions:

Patient engagement with clinical notes has the potential to enhance documentation accuracy and strengthen patient-clinician communication. To realize these benefits safely, such features must be deliberately designed and clearly explained to users, to avoid patient safety risks and unnecessary burden to HCPs.