Research Review

BIDMC Launches Pilot to Make Mental Health Notes Available to Patients

Writing for “A Piece of My Mind,” appearing April 2 in The Journal of the American Medical Association, lead author and Beth Israel Deaconess Medical Center psychiatrist, Michael Kahn, MD, urges mental health clinicians to begin sharing with their patients the visit notes they write.

“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,” says Kahn, who is an assistant professor of psychiatry at Harvard Medical School.

Reflecting the impact of the OpenNotes initiative, more than 2.5 million Americans, including patients at MD Anderson, Mayo Clinic, Cleveland Clinic, the VA, and BIDMC now have access to their medical notes. But, with the exception of the VA, medical institutions and systems do not share notes written by psychiatrists, psychologists, and social workers.

“We believe that such exclusions are unnecessary,” wrote the authors.

Kahn and colleagues acknowledge that offering access to mental health notes presents new challenges. “Inviting patients to read what clinicians write about their feelings, thoughts and behaviors does seem different from sharing assessments of their hypertension or diabetes,” and that for some patients, access could carry more risk than benefit. Still, they suggest, for the vast majority of patients, reading mental health notes could have an overall positive impact on their health and health care.

“Patients’ self-evaluations are often more negative than those of their clinicians,” wrote the authors. They say access to the notes has the potential to help patients feel less alone and diminish the shame patients can experience with a mental health diagnosis.

“For many patients the opportunity to read a treatment note can help improve accuracy and reduce stigma,” says Kahn. “And that may encourage patients to address their mental health issues more actively.”

“Anecdotally, some doctors have commented that inviting their patients to see the problems in writing was far more effective in catalyzing behavior change than was discussing them,” wrote the authors. They suggest that reading the note may become an important part of the treatment process for patients with mental illness.

Outpatient medical notes have been available at BIDMC since July 2013. Patients are invited to read their notes using a secure, confidential website. The medical center began piloting access to mental health notes in March 2014.

“In psychiatry, we have initiated a pilot program involving a portion of the patients we care for on an ongoing basis. From this group, we hope to learn more about how our patients respond and about any unforeseen problems our clinicians encounter. In this way, we can be thoughtful and deliberate as we implement OpenNotes,” says William Greenberg, MD, chief of psychiatry. “Based upon what we find, we hope to maximize the benefits of the program as we involve more and more of our patients.”

— Source: Beth Israel Deaconess Medical Center