PDF(Pubmed)
Abstract：
OBJECTIVE: In a growing list of countries, patients are granted access to their clinical notes (\"open notes\") as part of their online record access. Especially in the field of mental health, open notes remain controversial with some clinicians perceiving open notes as a tool for improving therapeutic outcomes by increasing patient involvement, while others fear that patients might experience psychological distress and perceived stigmatization, particularly when reading clinicians\' notes. More research is needed to optimize the benefits and mitigate the risks.
METHODS: Using a qualitative research design, we conducted semi-structured interviews with psychiatrists practicing in Germany, to explore what conditions they believe need to be in place to ensure successful implementation of open notes in psychiatric practice as well as expected subsequent changes to their workload and treatment outcomes. Data were analyzed using thematic analysis.
RESULTS: We interviewed 18 psychiatrists; interviewees believed four key conditions needed to be in place prior to implementation of open notes including careful consideration of (1) diagnoses and symptom severity, (2) the availability of additional time for writing clinical notes and discussing them with patients, (3) available resources and system compatibility, and (4) legal and data protection aspects. As a result of introducing open notes, interviewees expected changes in documentation, treatment processes, and doctor-physician interaction. While open notes were expected to improve transparency and trust, participants anticipated negative unintended consequences including the risk of deteriorating therapeutic relationships due to note access-related misunderstandings and conflicts.
CONCLUSIONS: Psychiatrists practiced in Germany where open notes have not yet been established as part of the healthcare data infrastructure. Interviewees were supportive of open notes but had some reservations. They found open notes to be generally beneficial but anticipated effects to vary depending on patient characteristics. Clear guidelines for managing access, time constraints, usability, and privacy are crucial. Open notes were perceived to increase transparency and patient involvement but were also believed to raise issues of stigmatization and conflicts.
METHODS: Using a qualitative research design, we conducted semi-structured interviews with psychiatrists practicing in Germany, to explore what conditions they believe need to be in place to ensure successful implementation of open notes in psychiatric practice as well as expected subsequent changes to their workload and treatment outcomes. Data were analyzed using thematic analysis.
RESULTS: We interviewed 18 psychiatrists; interviewees believed four key conditions needed to be in place prior to implementation of open notes including careful consideration of (1) diagnoses and symptom severity, (2) the availability of additional time for writing clinical notes and discussing them with patients, (3) available resources and system compatibility, and (4) legal and data protection aspects. As a result of introducing open notes, interviewees expected changes in documentation, treatment processes, and doctor-physician interaction. While open notes were expected to improve transparency and trust, participants anticipated negative unintended consequences including the risk of deteriorating therapeutic relationships due to note access-related misunderstandings and conflicts.
CONCLUSIONS: Psychiatrists practiced in Germany where open notes have not yet been established as part of the healthcare data infrastructure. Interviewees were supportive of open notes but had some reservations. They found open notes to be generally beneficial but anticipated effects to vary depending on patient characteristics. Clear guidelines for managing access, time constraints, usability, and privacy are crucial. Open notes were perceived to increase transparency and patient involvement but were also believed to raise issues of stigmatization and conflicts.
摘要：
目标：在越来越多的国家中，作为在线记录访问的一部分，患者可以访问其临床记录（“开放笔记”）。特别是在心理健康领域，开放笔记仍然存在争议，一些临床医生认为开放笔记是通过增加患者参与来改善治疗结果的工具，而其他人则担心患者可能会经历心理困扰和污名化，特别是在阅读临床医生的笔记时。需要更多的研究来优化收益并减轻风险。
方法：使用定性研究设计，我们对在德国执业的精神科医生进行了半结构化访谈，探讨他们认为需要具备哪些条件，以确保在精神病学实践中成功实施公开笔记，以及预期的工作量和治疗结果的后续变化。采用专题分析法对数据进行分析。
结果：我们采访了18名精神科医生；受访者认为，在实施公开笔记之前，需要做好四个关键条件，包括仔细考虑(1)诊断和症状严重程度，（2）有更多的时间来撰写临床笔记并与患者讨论，（3）可用资源和系统兼容性，（4）法律和数据保护方面。由于引入了公开笔记，受访者预期文档会发生变化，处理过程,和医生互动。虽然预计公开笔记会提高透明度和信任度，参与者预期会产生非预期的负面后果,包括由于与获取相关的误解和冲突而导致治疗关系恶化的风险.
结论：在德国执业的精神科医生尚未将公开笔记作为医疗保健数据基础设施的一部分。受访者支持公开笔记，但有一些保留。他们发现开放笔记通常是有益的，但预期效果会根据患者特征而有所不同。管理访问的明确准则，时间限制,可用性，隐私至关重要。公开笔记被认为增加了透明度和患者的参与，但也被认为引起了污名化和冲突的问题。
方法：使用定性研究设计，我们对在德国执业的精神科医生进行了半结构化访谈，探讨他们认为需要具备哪些条件，以确保在精神病学实践中成功实施公开笔记，以及预期的工作量和治疗结果的后续变化。采用专题分析法对数据进行分析。
结果：我们采访了18名精神科医生；受访者认为，在实施公开笔记之前，需要做好四个关键条件，包括仔细考虑(1)诊断和症状严重程度，（2）有更多的时间来撰写临床笔记并与患者讨论，（3）可用资源和系统兼容性，（4）法律和数据保护方面。由于引入了公开笔记，受访者预期文档会发生变化，处理过程,和医生互动。虽然预计公开笔记会提高透明度和信任度，参与者预期会产生非预期的负面后果,包括由于与获取相关的误解和冲突而导致治疗关系恶化的风险.
结论：在德国执业的精神科医生尚未将公开笔记作为医疗保健数据基础设施的一部分。受访者支持公开笔记，但有一些保留。他们发现开放笔记通常是有益的，但预期效果会根据患者特征而有所不同。管理访问的明确准则，时间限制,可用性，隐私至关重要。公开笔记被认为增加了透明度和患者的参与，但也被认为引起了污名化和冲突的问题。
