Einstellungen und Erwartungen von psychologischen und ärztlichen Psychotherapeut*innen gegenüber Open Notes: Analyse qualitativer Survey-Antworten

Zusammenfassung

Ziel Erforschung der Einstellungen und Erwartungen von Psychotherapeut*innen (PT) gegenüber eines digitalen, patientenseitigen Zugangs zu klinischen Verlaufsnotizen (engl. “Open Notes”; kurz: ON), einschließlich potentieller Vor- und Nachteile in der psychotherapeutischen Praxis.

Methodik Im Rahmen der PEPPPSY-Studie wurde ein Online-Survey zu dem o.g. Thema durchgeführt. Es wurden Freitextantworten (n = 107) qualitativ mittels thematischer Analyse ausgewertet.

Ergebnisse 129 Psychologische und ärztliche PT nahmen an der Befragung teil. PT sahen Vorteile wie Transparenz und patientenorientierte Dokumentation, befürchten aber auch Nachteile für die therapeutische Beziehung und einen erhöhten Workload durch die Einführung von ON. Es wurden Bedenken hinsichtlich Datensicherheit und negativer Auswirkungen auf die Behandlung geäußert. Empfehlungen zur Implementierung beinhalten patientenspezifische Anpassungen des Zugangs und begleitete Einsichtnahme der ON.

Schlussfolgerung PT zeigen eine ambivalente Haltung gegenüber ON. Weitere Forschung und Leitlinien zur Anwendung von ON in der Psychotherapie sind nötig.

Abstract

Objective This study explores attitudes and expectations of psychotherapists (PT) towards the introduction of digital patient access to clinical notes (“Open Notes”; ON)), including the advantages and disadvantages in psychotherapeutic practice.

Methods As part of the PEPPPSY study, an online survey was conducted. Free text responses (n = 107) were qualitatively analysed using thematic analysis.

Results 129 psychological and medical PT took part in the survey. PT saw advantages such as transparency and patient-centred documentation, but feared disadvantages for the therapeutic relationship and an increased workload through the implementation of ON. Concerns were raised about data security and negative effects on treatment. Recommendations for implementation include patient-specific access adaptations and guided access.

Conclusion PT are ambivalent about ON. Further research and guidelines for the use of ON in psychotherapy are needed.

Schlüsselwörter

Elektronische Patientenakte - Patientenportal - Persönliche Gesundheitsakte - Open Notes - Psychotherapie

Key words

electronic health record - patient portal - personal health record - open notes - psychotherapy

Publikationsverlauf

Eingereicht: 15. Dezember 2023

Angenommen: 06. Mai 2024

Artikel online veröffentlicht:
29. Mai 2024

• References

• 1 Delbanco T, Walker J, Bell SK. et al. Inviting patients to read their doctors’ notes: a quasi-experimental study and a look ahead. Ann Intern Med 2012; 157: 461-470
• 2 Essén A, Scandurra I, Gerrits R. et al. Patient access to electronic health records: Differences across ten countries. Health Policy Techn 2018; 7: 44-56
• 3 O’Neill S, Chimowitz H, Leveille S. et al. Embracing the new age of transparency: mental health patients reading their psychotherapy notes online. J Ment Health 2019; 28: 527-535
• 4 Bundesamt für Justiz. § 630g BGB – Einsichtnahme in die Patientenakte. Im Internet: https://www.gesetze-im-internet.de/bgb/__630g.html Stand: 26. 11.2023
• 5 Schwarz J, Bärkås A, Blease C. et al. Sharing Clinical Notes and Electronic Health Records With People Affected by Mental Health Conditions: Scoping Review. JMIR Ment Health 2021; 8: e34170
• 6 Cromer R, Denneson LM, Pisciotta M. et al. Trust in Mental Health Clinicians Among Patients Who Access Clinical Notes Online. Psychiatr Serv 2017; 68: 520-523
• 7 Peck P, Torous J, Shanahan M. et al. Patient access to electronic psychiatric records: A pilot study. Health Policy Techn 2017; 6: 309-315
• 8 O’Neill S, Blease C, Delbanco T. Open Notes Become Law: A Challenge for Mental Health Practice. Psychiatr Serv 2021; 72: 750-751
• 9 Denneson LM, Chen JI, Pisciotta M. et al. Patients’ Positive and Negative Responses to Reading Mental Health Clinical Notes Online. Psychiatr Serv 2018; 69: 593-596
• 10 Chimowitz H, O’Neill S, Leveille S. et al. Sharing Psychotherapy Notes with Patients: Therapists’ Attitudes and Experiences. Soc Work 2020; 65: 159-168
• 11 Denneson LM, Cromer R, Williams HB. et al. A Qualitative Analysis of How Online Access to Mental Health Notes Is Changing Clinician Perceptions of Power and the Therapeutic Relationship. J Med Internet Res 2017; 19: e208
• 12 Woods SS, Schwartz E, Tuepker A. et al. Patient experiences with full electronic access to health records and clinical notes through the My HealtheVet Personal Health Record Pilot: qualitative study. J Med Internet Res 2013; 15: e65
• 13 Schwarz J, Hoetger C, Pluschke L-S. et al. Psychiatrists’ perceptions of conditions and consequences associated with the implementation of open notes: qualitative investigation. BMC Psychiatry 2023;
• 14 Schwarz J, Meier-Diedrich E, Neumann K. et al. Reasons for Acceptance or Rejection of Online Record Access Among Patients Affected by a Severe Mental Illness: Mixed Methods Study. JMIR Ment Health 2024; 11: e51126
• 15 Bundesministerium für Gesundheit. Gesetz zur Beschleunigung der Digitalisierung des Gesundheitswesens (Digital-Gesetz – DigiG). Im Internet: https://www.bundesgesundheitsministerium.de/ministerium/gesetze-und-verordnungen/guv-20-lp/digig.html Stand: 01.10.2023
• 16 Schwarz J, Esch T. OpenNotes in Mental Health? Pro. Nervenarzt 2022; 93: 1163-1164
• 17 Hochwarter S, Fehler G, Muente C. et al. Design of a Patient-Accessible Electronic Health Record System in Mental Health. Stud Health Technol Inform 2022; 294: 583-584
• 18 Gibson M, Halvorsen M, Joner MAA. et al. Pilot Testing and Evaluation of Participatory Patient Record in Psychiatric Care. Proceedings of the 18th Scandinavian Conference on Health Informatics 2022;
• 19 Hochwarter S, Schwarz J. Facilitating Collaboration by Opening the Common Information Space in Mental Health Care. Infrahealth 2023 – Proceedings of the 9th International Conference on Infrastructures in Healthcare. 2023;
• 20 Clarke V, Braun V, Hayfield N. Thematic analysis. In: In: Smith, J.A., Ed., Qualitative Psychology: A Practical Guide to Research Methods. Lonodon: SAGE Publications; 2015: 222-248
• 21 Eysenbach G. Improving the quality of Web surveys: the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res 2004; 6: e34
• 22 Keuper J, Batenburg R, van Tuyl L. et al. General Practices’ Experiences With Patients' Web-Based Access to Medical Records: Survey Study. J Med Internet Res 2023; 25: e41832
• 23 Dobscha SK, Denneson LM, Jacobson LE. et al. VA mental health clinician experiences and attitudes toward OpenNotes. Gen Hosp Psychiatry 2016; 38: 89-93
• 24 Grünloh C, Myreteg G, Cajander Å. et al. “Why Do They Need to Check Me?” Patient Participation Through eHealth and the Doctor-Patient Relationship: Qualitative Study. J Med Internet Res 2018; 20: e8444
• 25 Grünloh C, Cajander Å, Myreteg G. “The record is our work tool!” – Physicians’ framing of a patient portal in Sweden. J Med Internet Res 2016; 18: e167
• 26 Davidge G, Brown L, Lyons M. et al. Primary care staff's views and experience of patients' online access to their electronic health record: a qualitative exploration. Br J Gen Pract 2023; 73: e418-e426
• 27 Müller J, Ullrich C, Poss-Doering R. Beyond Known Barriers – Assessing Physician Perspectives and Attitudes Toward Introducing Open Health Records in Germany: Qualitative Study. J Particip Med 2020; 12: e19093
• 28 Hägglund M, McMillan B, Whittaker R. et al. Patient empowerment through online access to health records. BMJ 2022; 378: e071531
• 29 Blease CR, O’Neill S, Walker J. Sharing notes with mental health patients: balancing risks with respect. Lancet Psychiatry 2020; 7: 924-925
• 30 Rudolf G. Psychodynamisch denken – tiefenpsychologisch handeln: Praxis der tiefenpsychologisch fundierten Psychotherapie. Stuttgart: Klett-Cotta; 2019
• 31 Wöller W, Kruse J. Tiefenpsychologisch fundierte Psychotherapie: Basisbuch und Praxisleitfaden. Stuttgart: Schattauer Verlag;; 2014
• 32 Turner A, Morris R, McDonagh L. et al. Unintended consequences of patient online access to health records: a qualitative study in UK primary care. Br J Gen Pract 2023; 73: e67-e74
• 33 Shucard H, Piepkorn MW, Reisch LM. et al. Dermatopathologists’ Experience With and Perceptions of Patient Online Access to Pathologic Test Result Reports. JAMA Dermatol 2020; 156: 320-324
• 34 Erlingsdóttir G, Petersson L, Jonnergård K. A Theoretical Twist on the Transparency of Open Notes: Qualitative Analysis of Health Care Professionals’ Free-Text Answers. J Med Internet Res 2019; 21: e14347
• 35 Psychotherapeutenkammer Berlin. Einsichtnahme in die Patientenakte bei Anfragen von Patienten (§ 630g BGB, §11 Berufsordnung). Im Internet: https://www.psychotherapeutenkammer-berlin.de/system/files/document/Merkblatt_630g-BGB.pdf Stand: 12.01.2023
• 36 Kristiansen E, Johansen M, Zanaboni P. Healthcare personnels’ experience with patients' online access to electronic health records: Differences between professions, regions, and somatic and psychiatric healthcare. Proceedings of the 17th Scandinavian Conference on Health Informatics. 2019 Im Internet: https://ep.liu.se/ecp/161/016/ecp19161016.pdf Stand 24.04.2024
• 37 Mafi JN, Gerard M, Chimowitz H. et al. Patients Contributing to Their Doctors’ Notes: Insights From Expert Interviews. Ann Intern Med 2018; 168: 302-305
• 38 Blease C. Open AI meets open notes: surveillance capitalism, patient privacy and online record access. J Med Ethics 2023; 50: 84-89
• 39 Blease C, Torous J, Maria MBH. et al. Generative Language Models Writing Open Notes: Exploring the Promise and Limitations. JMIR Med Educ 2024; 10: e51183
• 40 Meier-Diedrich E, Davidge G, Hägglund M. et al. Changes in Documentation Due to Patient Access to Electronic Health Records: Protocol for a Scoping Review. JMIR Res Protoc 2023; 12: e46722
• 41 Schwarz J, Neumann K, Mühlensiepen F. et al. Attitudes and Anticipated Effects of Open Notes in Psychotherapy: An Online Survey of Psychotherapists in Germany. Digital Health 2024; 10