Boston's Beth Israel Deaconess Medical Center has launched a pilot in which 700 mental health patients receive access to their therapists' notes on their laptop or smartphone, according to a must-read report in the New York Times.
"Nationally, the momentum is shifting in favor of transparency in the medical record, but understandable caution and controversy remain when it comes to mental health notes,” lead author and assistant professor of psychiatry at Harvard Medical School, Dr Michael Kahn, wrote in a Journal of the American Medical Association (JAMA) article on the pilot.
This pilot is an extension of a rather famous trial that Beth Israel participated in a few years ago, called OpenNotes. In the OpenNotes program, which was funded by the Robert Wood Johnson Foundation, more than 13,500 primary care patients were given access to their physicians’ notes via an online portal and electronic messaging. More than 100 physicians participated in that trial. In the end, close to 11,800 patients opened at least one note during the study, which took place at two other healthcare facilities as well: Geisinger Health System (GHS) in Pennsylvania and Harborview Medical Center (HMC) in Washington.
At the time, the study authors explained that a vast majority of the participating patients said they could understand their medical issues more easily, better remember their treatment plans, and prepare for future visits. Patients also found that they felt an increased sense of control.
Since then, more than 2.5 million American patients from several healthcare institutions including MD Anderson, Mayo Clinic, Cleveland Clinic, and the Department of Veteran’s Affairs (VA) have been given access to their medical notes. Still, with the exception of the VA, a release from the researchers explained these institutions do not share notes written by psychiatrists, psychologists, and social workers. The researchers write in the JAMA article that they find these exclusions unnecessary.
"Inviting patients to read what clinicians write about their feelings, thoughts and behaviors does seem different from sharing assessments of their hypertension or diabetes," Kahn said. "Bringing transparency into mental health feels like entering a minefield, triggering clinicians' worst fears about sharing notes with patients."
Some concerns that exist, according to Kahn, include how a patient will react to reading a diagnosis of his personality disorder and what a patient with schizophrenia will feel when a therapist writes that her "firm convictions" are delusional. Still, according to the researchers, allowing patients to read therapist notes might help them address their mental health issues actively and reduce the stigma that they feel around mental health.