Impact on patient-provider relationship and documentation practices when mental health patients access their electronic health records online: a qualitative study among health professionals in an outpatient setting.

BACKGROUND: Patient accessible electronic health records (PAEHR) hold the potential to increase patient empowerment, especially for patients with complex, long-term or chronic conditions. However, evidence of its benefits for patients who undergo mental health treatment is unclear and inconsistent, and several concerns towards use of PAEHR emerged among health professionals. This study aimed at exploring the impact of PAEHR among mental health professionals in terms of patient-provider relationship, changes in the way of writing in the electronic health records and reasons for denying access to information. METHODS: In-depth qualitative interviews with health professionals working in two mental health outpatient clinics at Helgelandssykehuset in Northern Norway, one of the first hospitals in Norway to implement the PAEHR in 2015. The interviews were conducted by phone or videoconferencing, audio recorded and transcribed verbatim. Data were analyzed by a multidisciplinary research team using the Framework Method. RESULTS: A total of 16 in-depth qualitative interviews were conducted in April and May 2020. The PAEHR implemented in Norway was seen as a tool to increase transparency and improve the patient-provider relationship. The PAEHR was seen to have negative consequences only in limited situations, such as for patients with severe mental conditions, for child protective services when parents access their children's journal, or for patients with abusive partners. The functionality to deny access to the journal was used rarely. A more common practice for making information not immediately available was to delay the final approval of the notes. The documentation practices changed over the years, but it was not clear to what extent the changes were attributable to the introduction of the PAEHR. Health professionals write their notes keeping in mind that patients might read them, and they try to avoid unclear language, information about third parties, and hypotheses that might create confusion. CONCLUSIONS: The concerns voiced by mental health professionals regarding the impact of the PAEHR on the patient-provider relationship and practices to deny access to information were not supported by the results of this study. Future research should explore changes in documentation practices by analysing the content of the electronic health records.

Patient Use and Experience With Online Access to Electronic Health Records in Norway: Results From an Online Survey.

BACKGROUND: The electronic health record (EHR) has been fully established in all Norwegian hospitals. Patient-accessible electronic health records (PAEHRs) are available to citizens aged 16 years and older through the national health portal Helsenorge. OBJECTIVE: This study aimed at understanding how patients use PAEHRs. Three research questions were addressed in order to explore (1) characteristics of users, (2) patients' use of the service, and (3) patient experience with the service. METHODS: We conducted an online survey of users who had accessed their EHR online at least once through the national health portal. Patients from two of the four health regions in Norway were invited to participate. Quantitative data were supplemented by qualitative information. RESULTS: A total of 1037 respondents participated in the survey, most of whom used the PAEHR regularly (305/1037, 29.4%) or when necessary (303/1037, 29.2%). Service utilization was associated with self-reported health, age, gender, education, and health care professional background. Patients found the service useful to look up health information (687/778, 88.3%), keep track of their treatment (684/778, 87.9%), prepare for a hospital appointment (498/778, 64.0%), and share documents with their general practitioner (292/778, 37.5%) or family (194/778, 24.9%). Most users found it easy to access their EHR online (965/1037, 93.1%) and did not encounter technical challenges. The vast majority of respondents (643/755, 85.2%) understood the content, despite over half of them acknowledging some difficulties with medical terms or phrases. The overall satisfaction with the service was very high (700/755, 92.7%). Clinical advantages to the patients included enhanced knowledge of their health condition (565/691, 81.8%), easier control over their health status (685/740, 92.6%), better self-care (571/653, 87.4%), greater empowerment (493/674, 73.1%), easier communication with health care providers (493/618, 79.8%), and increased security (655/730, 89.7%). Patients with complex, long-term or chronic conditions seemed to benefit the most. PAEHRs were described as useful, informative, effective, helpful, easy, practical, and safe. CONCLUSIONS: PAEHRs in Norway are becoming a mature service and are perceived as useful by patients. Future studies should include experimental designs focused on specific populations or chronic conditions that are more likely to achieve clinically meaningful benefits. Continuous evaluation programs should be conducted to assess implementation and changes of wide-scale routine services over time.

Health Professionals' Experience with Patients Accessing Their Electronic Health Records: Results from an Online Survey.

The aim of this study was to investigate hospital professionals' experience and attitude with patients accessing their own electronic health records. The study was conducted one year after service establishment. Data was collected through an online survey. In total, 457 replies were received. The results revealed a quarter of the administrative staff received feedback from patients or relatives regarding mistakes or missing information in their EHR. In addition, 67.5% of health professionals expected more patients to have basic knowledge of their health status in the future, and 21.4% found patients already gained better knowledge about diagnosis, treatment, or follow-up. The results also revealed some challenges with the service, especially for health professionals working in psychiatry, with some scepticism on whether the service is suitable for the sickest and most vulnerable patients.

Developing and Implementing Patients' Full-Scale Electronic Access to Their Health Record.

To increase patients' empowerment and involvement in their own health, several countries has decided to provide patients with electronic access to their health record. This paper reports on the main findings from sub-studies and pilots prior to the implementation of patients' access to their medical records in large-scale in the Northern Norway Region. The largest pilot included nearly 500 patients. Data for the participatory design process was collected through questionnaires and interviews. The results revealed that the service in general functioned as expected. The patients reported that they would continue to use the service, recommend it to others, and generally had no problems in understanding the content.

Using the Internet to Support Exercise and Diet: A Stratified Norwegian Survey.

BACKGROUND: Internet is used for a variety of health related purposes. Use differs and has differential effects on health according to socioeconomic status. OBJECTIVE: We investigated to what extent the Norwegian population use the Internet to support exercise and diet, what kind of services they use, and whether there are social disparities in use. We expected to find differences according to educational attainment. METHODS: In November 2013 we surveyed a stratified sample of 2196 persons drawn from a Web panel of about 50,000 Norwegians over 15 years of age. The questionnaire included questions about using the Internet, including social network sites (SNS), or mobile apps in relation to exercise or diet, as well as background information about education, body image, and health. The survey email was opened by 1187 respondents (54%). Of these, 89 did not click on the survey hyperlink (declined to participate), while another 70 did not complete the survey. The final sample size is thus 1028 (87% response rate). Compared to the Norwegian census the sample had a slight under-representation of respondents under the age of 30 and with low education. The data was weighted accordingly before analyses. RESULTS: Sixty-nine percent of women and 53% of men had read about exercise or diet on the Internet (χ(2)= 25.6, P<.001). More people with higher education (71%, χ(2)=19.1, P<.001), reported this. The same gender difference was found for using Internet-based interventions with 20% of women compared to14% of men reporting having used these interventions (χ(2)=7.9, P= .005), for having posted a status about exercise or diet on Facebook or other SNS (23% vs 12%, χ(2)=18.8, P<.001), and for having kept an online exercise or diet journal (21% vs 15%, χ(2)=7.0, P=.008). Evaluations of own physical appearance accounted for some of the gender differences in using online exercise or diet journals. Seven percent of the total sample reported having used electronic communication to ask professionals about exercise or diet, while a few more had discussed online with peers (10%). Asking professionals online was more common amongst those with only primary education (13%, χ(2)<10.5, P=.005).  CONCLUSIONS: Gender and education are related to how the Internet is used to support health behaviors. We should be aware of the potential role of the Internet in accelerating social disparities in health, and continue to monitor population use. For Internet- and mobile-based interventions to support health behaviors, this study provides information relevant to tailoring of delivery media and components to user.

A qualitative description of telemedicine for acute stroke care in Norway: technology is not the issue.

BACKGROUND: To assist small hospitals in providing advanced stroke treatment, the Norwegian Directorate of Health has recommended telemedicine services. Telestroke enables specialists to examine patients via videoconferencing supplemented by teleradiology and to provide decision support to local health care personnel. There is evidence that telestroke increases thrombolysis rates. In Norway, telemedicine has mainly been used in non-critical situations. The first telestroke trials took place in 2008. The aim of this paper is to present an overview of telestroke trials and today's status with telestroke in Norway. Based on the divergent experience from two health regions in Norway, the paper discusses crucial factors for the integration of telestroke in clinical practice. METHODS: This is a descriptive study based on multiple methods to obtain an overview of the practice and experience with telestroke in Norway. A Web and literature search for 'telestroke in Norway' was performed and compared with a survey of telemedicine services at the country's largest hospitals. These findings were supplemented by interviews with key personnel involved in telestroke in two of four health regions, as well as hospital field observations and log data of telestroke transmissions from five of the hospitals involved. RESULTS: In Norway, experience in telemedicine for acute stroke care is limited. At the beginning of 2014, three of four regional health authorities were working with telestroke projects and services. Integration of the service in practice is challenging, with varying experience. The problems are not attributed to the technology in itself, but to organization (availability of staff on duty 24/7 and surveillance of the systems), motivation of staff, logistics (patient delay), and characteristics of the buildings (lack of space). CONCLUSIONS: Prerequisites for successful integration of telestroke in clinical practice include realization of the collaboration potential in the technology with consistent procedures for training and triage, availability of the equipment, and providing advice beyond questions concerning thrombolysis.

Online communication between doctors and patients in Europe: status and perspectives.

BACKGROUND: Use of the Internet for health purposes is steadily increasing in Europe, while the eHealth market is still a niche. Online communication between doctor and patient is one aspect of eHealth with potentially great impact on the use of health systems, patient-doctor roles and relations and individuals' health. Monitoring and understanding practices, trends, and expectations in this area is important, as it may bring invaluable knowledge to all stakeholders, in the Health 2.0 era. OBJECTIVE: Our two main goals were: (1) to investigate use of the Internet and changes in expectations about future use for particular aspects of communication with a known doctor (obtaining a prescription, scheduling an appointment, or asking a particular health question), and (2) to investigate how important the provision of email and Web services to communicate with the physician is when choosing a new doctor for a first time face-to-face appointment. The data come from the second survey of the eHealth Trends study, which addressed trends and perspectives of health-related Internet use in Europe. This study builds on previous work that established levels of generic use of the Internet for self-help activities, ordering medicine or other health products, interacting with a Web doctor/unknown health professional, and communicating with a family doctor or other known health professional. METHODS: A representative sample of citizens from seven European countries was surveyed (n = 7022) in April and May of 2007 through computer-assisted telephone interviews (CATI). Respondents were questioned about their use of the Internet to obtain a prescription, schedule an appointment, or ask a health professional about a particular health question. They were also asked what their expectations were regarding future use of the Internet for health-related matters. In a more pragmatic approach to the subject, they were asked about the perceived importance when choosing a new doctor of the possibility of using email and the Web to communicate with that physician. Logistic regression analysis was used to draw the profiles of users of related eHealth services in Europe among the population in general and in the subgroup of those who use the Internet for health-related matters. Changes from 2005 to 2007 were computed using data from the first eHealth Trends survey (October and November 2005, n = 7934). RESULTS: In 2007, an estimated 1.8% (95% confidence interval [CI], 1.5 - 2.1) of the population in these countries had used the Internet to request or renew a prescription; 3.2% (95% CI 2.8 - 3.6) had used the Internet to schedule an appointment; and 2.5% (95% CI 2.2 - 2.9) had used the Internet to ask a particular health question. This represents estimated increases of 0.9% (95% CI 0.5 - 1.3), 1.7% (95% CI 1.2 - 2.2), and 1.4% (95% CI 0.9 - 1.8). An estimated 18.0% (95% CI 17.1 - 18.9) of the populations of these countries expected that in the near future they would have consultations with health professionals online, and 25.4% (95% CI 24.4 - 26.3) expected that in the near future they would be able to schedule an appointment online. Among those using the Internet for health-related purposes, on average more than 4 in 10 people considered the provision of these eHealth services to be important when choosing a new doctor. CONCLUSIONS: Use of the Internet to communicate with a known health professional is still rare in Europe. Legal context, health policy issues, and technical conditions prevailing in different countries might be playing a major role in the situation. Interest in associated eHealth services is high among citizens and likely to increase.

Use of the internet for health purposes: trends in Norway 2000-2010.

AIM: The aim of this work is to study the 10 year trends in the use and projected use of internet for health purposes in Norway. This includes more detailed analyses of changes in latter years, current uses, valuation as source of health information, reported effects and projected developments. METHOD: Surveys on the use of the internet for health purposes have been conducted in Norway in the years 2000, 2001, 2003, 2005 and 2007. Representative samples were drawn from the population, and interviews were conducted by poll agencies using telephone (CATI). RESULTS: Internet use for health purposes in the Norwegian population has increased dramatically over the last 7 years from 19% in 2000 to 67% in 2007. If this trend continues, we estimate that 84% of the Norwegian population will be using internet for health purposes by the year 2010. Reading about health or illness is the most common activity, and the rated importance of the internet as a source of health information is increasing. The internet is also used more for ordering medicines and other health-related products. Forty-four per cent of those having used the internet for health purposes reported having searched for lifestyle-related information, and 40% reported having felt inspired to change health behaviour. CONCLUSIONS: The internet is an important source of health information, which is likely to increase in importance in the years to come. This study further underlines the potential of internet use for health promoting purposes, as well as the potential for exacerbating social disparities in health.

[Developments in the population's use of the internet for health-related purposes]. / Udviklingen i befolkningens brug af internettet til sundhedsrelaterede formål.

INTRODUCTION: We wish to study the development in the Danish population's use of the internet for health-related purposes. What has changed from 2005 to 2007? Who is the typical user and what exactly is the internet used for? MATERIAL AND METHODS: As part of a larger EU-funded survey, 1,000 randomly selected Danes between 15-80 years of age completed a questionnaire in the fall 2005. The same questions were put to 1.021 Danes in the spring of 2007 to study any trends. RESULTS: A total of 72% of the Danes use the internet when searching for information on health. This constitutes an increase of 20% from 2005. Personal contact with the general practitioner (GP) is still the most important source of health and illness information, but more than 50% also consider the internet to be an important or very important source of health information. Women are still more active than men when searching for health information. A total of 20% of the Danes have consulted their own GP online, which is a 161% increase. Also, it has become more important for the Danes when choosing a GP that he or she offers eServices. CONCLUSION: The Danes' use of the internet for health information purposes has increased. And when the Danes seek health and illness information, it is primarily used to decide if the GP should be consulted. The GP remains the primary source of information and the Danes consult with their GP more and more frequently via the internet.

A review of ICT systems for HIV/AIDS and anti-retroviral treatment management in South Africa.

Telemedicine and e-health systems have been proposed as a support tool, to monitor and evaluate HIV/AIDS management strategies. The aim of the present study was to provide an overview of telemedicine and e-health systems for HIV/AIDS in South Africa as a basis for developing an e-health toolkit for anti-retroviral treatment (ART). An initial literature review and a subsequent interactive networking approach were chosen to identify telemedicine and e-health systems, projects and services for HIV/AIDS and ART facilities in low-resource settings and under-served areas. The literature review produced little useful information. In contrast, the face-to-face interviews and the focus group discussions provided useful information about projects and systems which had not been published. The meetings involved 1 - 5 people per session, about 30 people in total. The review showed that there were some plans for telemedicine and e-health implementation in South Africa. However, there was no all-inclusive ICT-based system in place for AIDS treatment there. With the exception of the major health information systems and electronic patient record systems, none of the telemedicine and e-health systems identified in the review were ready to be deployed across the country as a whole.

Relations between Internet use, socio-economic status (SES), social support and subjective health.

This study aimed to explore relations between Internet use, socio-economic status (SES), social support and subjective health. Participants were from representative samples between 15 and 80 years of age from seven different European countries. Two different survey datasets were used: (i) eHealth trends (eHT; N = 7934) and (ii) the European social survey (ESS2; N = 11248). Internet users who had used the Internet for health purposes were compared with Internet users who had not used it for health purposes. Structural equation modelling was used to assess the relationships between SES, Internet use, social support and subjective health. Use of other media was compared to Internet use in relation to social support and subjective health. Internet use was found to be more closely related to social support and subjective health than use of other media. Internet use was also found to be a plausible mediator between SES and subjective health, especially through interacting with social support.

[Health-related use of the Internet in the Norwegian population]. / Helserelatert bruk av Internett i den norske befolkningen.

BACKGROUND: The use of the Internet for health purposes increases in the Norwegian population, more in some demographic groups than in others. In this questionnaire-based study, we explore the use of the Internet for such purposes. MATERIAL AND METHOD: 1007 Norwegians aged 15 years and older were interviewed by telephone in October 2005. RESULTS: 58% of the respondents in 2005 had used the Internet for health purposes, compared to 31% in 2001. Having visited the GP last year, being female, being young, living in a urban area, and having a white-collar occupation were positively related to the use of the Internet for health purposes. 37% of the respondents considered the Internet to be an important or very important source of health information. 72% considered face-to-face communication with health care personnel to be important or very important. Nearly a quarter of the users (23%) reported that they had felt reassured by health information found on the net, whereas 10 % experienced increased anxiety from the same type of information. CONCLUSIONS: Norwegians' use of the Internet for health purposes continues to grow, but doctors and other health care personnel remain the most important sources of health information in the Norwegian population.