Findings from Lund University in Medical Internet Research Reported (A Theoretical Twist on the Transparency of Open Notes: Qualitative Analysis of Health Care Professionals’ Free-Text Answers)

2019 OCT 23 (NewsRx) -- By a News Reporter-Staff News Editor at Internet Daily News -- Researchers detail new data in Internet and World Wide Web - Medical Internet Research. According to news originating from Lund, Sweden, by NewsRx correspondents, research stated, “The New Public Management movement strove for transparency so that policy makers and citizens could gain insight into the work and performance of health care. As the use of the electronic health record (EHR) started to diffuse, a foundation was laid for enhanced transparency within and between health care organizations.”

Financial support for this research came from AFA Insurance in Sweden.

Our news journalists obtained a quote from the research from Lund University, “Now we appear to be experiencing a new kind of transparency in the health care sector. Many health care providers offer their patients online access to their EHRs (here referred to as Open Notes). The Open Notes system enables and strives for transparency between the health care organization and the patient. Hence, this study investigates health care professional (HCP) perceptions of Open Notes and deepens the understanding of the transparency that Open Notes implies. Based on two survey studies of HCP perceptions of Open Notes, this paper aims to deepen the academic writing on the type of transparency that is connected to Open Notes. HCPs in adult psychiatry in Region Skane, Sweden, were surveyed before and after implementation of Open Notes. The empirical material presented consists of 1554 free-text answers from two Web surveys. A qualitative content analysis was performed. The theoretically informed analysis pivots around the following factors connected to transparency: effectiveness; trust; accountability; autonomy and control; confidentiality, privacy, and anonymity; fairness; and legitimacy. The results show that free-text answers can be sorted under these factors as trade-offs with transparency. According to HCPs, trade-offs affect their work, their relationship with patients, and not least, their work tool, the EHR. However, since many HCPs also state that they have not met many patients, and in some cases none, who have read their EHRs, these effects seem to be more connected to the possibility (or threat) of transparency than to the actual effectuated transparency. The implementation (or reform) of Open Notes is policy driven while demanding real-time transparency on behalf of citizens/patients and not the authorities, which makes this particular form of transparency quite unique and interesting. We have chosen to call it governed individual real-time transparency. The effects of Open Notes may vary between different medical specialties relative to their sensitivity to both total and real-time transparency. When HCPs react by changing their ways of writing notes, Open Notes can affect the efficiency of the work of HCPs and the service itself in a negative manner. HCP reactions are aimed primarily at protecting patients and their relatives as well as their own relationship with the patients and secondly at protecting themselves. Thus, governed individual real-time transparency that provides full transparency of an actual practice in health care may have the intended positive effects but can also result in negative trade-offs between transparency and efficiency of the actual practice.”

According to the news editors, the research concluded: “This may imply that full transparency is not always most desirable but that other options can be considered on a scale between none and full transparency.”

For more information on this research see: A Theoretical Twist on the Transparency of Open Notes: Qualitative Analysis of Health Care Professionals’ Free-Text Answers. Journal of Medical Internet Research, 2019;21(9):e14347. Journal of Medical Internet Research can be contacted at: Jmir Publications, Inc, 130 Queens Quay E, Ste 1102, Toronto, On M5A 0P6, Canada.

The news correspondents report that additional information may be obtained from L. Petersson, Lund University, Dept. of Design Sciences, Box 118, Lund, Sweden. Additional authors for this research include G. Erlingsdottir and K. Jonnergard.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.2196/14347. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

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