Patients' Positive and Negative Responses to Reading Mental Health Clinical Notes Online

Objective: This study describes responses to Open Notes, clinical notes available online, among patients receiving mental health care and explores whether responses vary by patient demographic or clinical characteristics. Methods: Survey data from 178 veterans receiving mental health treatment at a large Veterans Affairs medical center included patient-reported health self-efficacy, health knowledge, alliance with clinicians, and negative emotional responses after reading Open Notes. Health care data were extracted from the patient care database. Results: Reading OpenNotes helped many participants feel in control of their health care (49%) and have more trust in clinicians (45%), although a few (8%) frequently felt upset after reading their notes. In multivariate models, posttraumatic stress disorder was associated with increased patient-clinician alliance (p=. 046) but also with negative emotional responses (p<.01). Conclusions: Patients receiving mental health care frequently reported benefits from reading OpenNotes, yet some experienced negative responses.