Openness of patients' reporting with use of electronic records: psychiatric clinicians' views
- Ronald M Salomon1,
- Jennifer Urbano Blackford1,
- S Trent Rosenbloom2,3,
- Sandra Seidel1,
- Ellen Wright Clayton3,4,
- David M Dilts5,6,7,
- Stuart G Finder8,9
- 1Department of Psychiatry, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- 2Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- 3Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
- 4Department of Law, Vanderbilt University School of Law, Nashville, Tennessee, USA
- 5Knight Cancer Institute, Oregon Health & Science University, Portland, Oregon, USA
- 6Division of Management, Oregon Health & Science University, Portland, Oregon, USA
- 7Center for Management Research in Healthcare, Oregon Health & Science University, Portland, Oregon, USA
- 8Center for Healthcare Ethics and Departments of Surgery and Biomedical Science, Cedars-Sinai Medical Center, Los Angeles, California, USA
- 9Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
- Correspondence to Dr Ronald M Salomon, Division of Adult Psychiatry, Vanderbilt Psychiatric Hospital, 3rd Floor, 1601 23rd Avenue South, Nashville, TN 37212, USA; ron.salomon{at}vanderbilt.edu
- Received 12 July 2009
- Accepted 20 October 2009
Abstract
Objectives Improvements in electronic health record (EHR) system development will require an understanding of psychiatric clinicians' views on EHR system acceptability, including effects on psychotherapy communications, data-recording behaviors, data accessibility versus security and privacy, data quality and clarity, communications with medical colleagues, and stigma.
Design Multidisciplinary development of a survey instrument targeting psychiatric clinicians who recently switched to EHR system use, focus group testing, data analysis, and data reliability testing.
Measurements Survey of 120 university-based, outpatient mental health clinicians, with 56 (47%) responding, conducted 18 months after transition from a paper to an EHR system.
Results Factor analysis gave nine item groupings that overlapped strongly with five a priori domains. Respondents both praised and criticized the EHR system. A strong majority (81%) felt that open therapeutic communications were preserved. Regarding data quality, content, and privacy, clinicians (63%) were less willing to record highly confidential information and disagreed (83%) with including their own psychiatric records among routinely accessed EHR systems.
Limitations single time point; single academic medical center clinic setting; modest sample size; lack of prior instrument validation; survey conducted in 2005.
Conclusions In an academic medical center clinic, the presence of electronic records was not seen as a dramatic impediment to therapeutic communications. Concerns regarding privacy and data security were significant, and may contribute to reluctances to adopt electronic records in other settings. Further study of clinicians' views and use patterns may be helpful in guiding development and deployment of electronic records systems.
- Health care technology
- health surveys
- national health policy
- health services research
- medical record technicians
- personal health records
- computerized medical records systems
- quality of health care
Footnotes
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Preliminary results were reported to the Cal Turner Program in Medical Ethics at Vanderbilt in 2006 but have not been made accessible to the informatics or other literatures.
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Funding The survey project was supported by a grant from the Cal Turner Program in Medical Ethics at Vanderbilt University (to RMS and most coauthors). Preparation of the manuscript was also assisted by support from the National Institute of Mental Health (JUB, K01-MH083052) and from the United States National Library of Medicine (STR, R01LM009591-01).
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Competing interests None.
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Provenance and peer review Not commissioned; externally peer reviewed.
