Abstract
BackgroundPatients in a range of health care sectors can access their medical health records using a patient portal. In mental health care, the use of patient portals among mental health care professionals remains low. Mental health care professionals are concerned that patient access to electronic health records (EHRs) will negatively affect the patient’s well-being and privacy as well as the professional’s own workload. ObjectiveThis study aims to provide insights into the appraisal work of mental health care professionals to assess and understand patient access to their EHRs through a patient portal.MethodsWe conducted a qualitative study that included 10 semistructured interviews (n=11) and a focus group (n=10). Participants in both the interviews and the focus group were mental health care professionals from different professional backgrounds and staff employees (eg, team leaders and communication advisors). We collected data on their opinions and experiences with the recently implemented patient portal and their attempts to modify work practices.ResultsOur study provides insights into mental health care professionals’ appraisal work to assess and understand patient access to the EHR through a patient portal. A total of four topics emerged from our data analysis: appraising the effect on the patient-professional relationship, appraising the challenge of sharing and registering delicate information, appraising patient vulnerability, and redefining consultation routines and registration practices.ConclusionsMental health care professionals struggle with the effects of web-based patient access and are searching for the best ways to modify their registration and consultation practices. Our participants seem to appraise the effects of web-based patient access individually. Our study signals the lack of systematization and communal appraisal. It also suggests various solutions to the challenges faced by mental health care professionals. To optimize the effects of web-based patient access to EHRs, mental health care professionals need to be involved in the process of developing, implementing, and embedding patient portals.
Highlights
BackgroundThe number of patient portals is increasing rapidly in all health care sectors
The following two quotes illustrate the strong differences in opinions among the interviewed mental health care professionals: I must honestly say that I have not thought about the possible benefits
Our results show that mental health care professionals struggle with various aspects of patient access to the electronic health record normalization process theory (NPT) (EHR) and with entering what they perceive as sensitive information into the EHR
Summary
BackgroundThe number of patient portals is increasing rapidly in all health care sectors. Overall consequences can be positive, for example, improved registration (ie, documentation) and consultations (ie, visits) with patients or negative, for example, reduced documentation by mental health care professionals This suggests that the positive effects of web-based patient access partly depend on the registration practices of the mental health care professional and the ways in which they communicate with their patients [3,4]. To gain insight into the challenges of mental health care professionals, we use the normalization process theory (NPT), which helps to understand how new technologies and practices are embedded and integrated into existing work practices [5] This theory “identifies, characterises and explains mechanisms that have been empirically demonstrated to motivate and shape implementation processes and affect their outcomes” [6]. Reflexive monitoring sheds light on the individual mental health care professionals’ appraisal work shortly after the implementation of web-based patient access. To optimize the effects of web-based patient access to EHRs, mental health care professionals need to be involved in the process of developing, implementing, and embedding patient portals
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