ArticlePloS one2021
The benefits and harms of open notes in mental health: A Delphi survey of international experts.
Article in PloS one, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
20 citing papers in PubMed.
- An Evaluation of AI-Generated Clinical Notes in the OpenNotes Era: A Thematic Analysis of Clinician Discourse.Journal of evaluation in clinical practice · 2026Article
- Understanding Patient-Reported Offenses in Electronic Health Records: Cross-Sectional Mixed Methods Survey.Journal of medical Internet research · 2026Article
- Perspectives on Health Data Sharing Among Patients With Somatic and Mental Health Diseases: Focus Group Study.Journal of medical Internet research · 2026Article
- Chaplains' Charting in the USA in the Era of "Open Notes:" Recommendations from a Quality Improvement Project.Journal of religion and health · 2026Article
- Open Notes in Mental Health: A Scoping Review of Stakeholder Experiences and Implications for Clinical Practice.Healthcare (Basel, Switzerland) · 2025Review
- Placebo, Nocebo, and Machine Learning: How Generative AI Could Shape Patient Perception in Mental Health Care.JMIR mental health · 2025Article
- Patient Factors Associated With the Use of Online Portal Health Information in the Postpandemic Era: Cross-Sectional Analysis of a National Survey.Journal of medical Internet research · 2025Article
- Patient-Accessible Electronic Health Records and Information Practices in Mental Health Care Contexts: Scoping Review.Journal of medical Internet research · 2025Article
- Perceptions of electronic health records by ethnically diverse groups in mental health: A systematic literature review.Global mental health (Cambridge, England) · 2025Review
- Experiences from patients in mental healthcare accessing their electronic health records: results from a cross-national survey in Estonia, Finland, Norway, and Sweden.BMC psychiatry · 2024Article
- Psychiatrists' perceptions of conditions and consequences associated with the implementation of open notes: qualitative investigation.BMC psychiatry · 2024Article
- Development of Recommendations for the Digital Sharing of Notes With Adolescents in Mental Health Care: Delphi Study.JMIR mental health · 2024Article
- Shifting Mindsets: The Impact of a Patient Portal on Functioning and Recovery in a Mental Health Setting.Canadian journal of psychiatry. Revue canadienne de psychiatrie · 2024Article
- Personalized Roadmaps for Returning Results From Digital Phenotyping.The American journal of bioethics : AJOB · 2024Article
- Users' Experiences With Online Access to Electronic Health Records in Mental and Somatic Health Care: Cross-Sectional Study.Journal of medical Internet research · 2023Article
- Errors, Omissions, and Offenses in the Health Record of Mental Health Care Patients: Results from a Nationwide Survey in Sweden.Journal of medical Internet research · 2023Article
- Patient Online Record Access in English Primary Care: Qualitative Survey Study of General Practitioners' Views.Journal of medical Internet research · 2023Article
- Impact of a switch to immediate release on the patient viewing of diagnostic test results in an online portal at an academic medical center.Journal of pathology informatics · 2023Article
- Article
- Open notes in psychotherapy: An exploratory mixed methods survey of psychotherapy students in Switzerland.Digital healthArticle
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
10 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
importanceAs of April 5, 2021, as part of the 21st Century Cures Act, new federal rules in the U.S. mandate that providers offer patients access to their online clinical records.
objectiveTo solicit the view of an international panel of experts on the effects on mental health patients, including possible benefits and harms, of accessing their clinical notes.
designAn online 3-round Delphi poll.
settingOnline.
participantsInternational experts identified as clinicians, chief medical information officers, patient advocates, and informaticians with extensive experience and/or research knowledge about patient access to mental health notes. MAIN OUTCOMES, AND MEASURES: An expert-generated consensus on the benefits and risks of sharing mental health notes with patients.
resultsA total of 70 of 92 (76%) experts from 6 countries responded to Round 1. A qualitative review of responses yielded 88 distinct items: 42 potential benefits, and 48 potential harms. A total of 56 of 70 (80%) experts responded to Round 2, and 52 of 56 (93%) responded to Round 3. Consensus was reached on 65 of 88 (74%) of survey items. There was consensus that offering online access to mental health notes could enhance patients' understanding about their diagnosis, care plan, and rationale for treatments, and that access could enhance patient recall and sense of empowerment. Experts also agreed that blocking mental health notes could lead to greater harms including increased feelings of stigmatization. However, panelists predicted there could be an increase in patients demanding changes to their clinical notes, and that mental health clinicians would be less detailed/accurate in documentation. CONCLUSIONS AND RELEVANCE: This iterative process of survey responses and ratings yielded consensus that there would be multiple benefits and few harms to patients from accessing their mental health notes. Questions remain about the impact of open notes on professional autonomy, and further empirical work into this practice innovation is warranted.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.