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Patient online record access (ORA) is spreading worldwide, and in some countries, including Sweden, and the USA, access is advanced with patients obtaining rapid access to their full records. In the UK context, from 31 October 2023 as part of the new NHS England general practitioner (GP) contract it will be mandatory for GPs to offer ORA to patients aged 16 and older. Patients report many benefits from reading their clinical records including feeling more empowered, better understanding and remembering their treatment plan, and greater awareness about medications including possible adverse effects. However, a variety of indirect evidence suggests these benefits are unlikely to accrue without supplementation from internet-based resources. Using such routes to augment interpretation of the data and notes housed in electronic health records, however, comes with trade-offs in terms of exposing sensitive patient information to internet corporations. Furthermore, increased work burdens on clinicians, including the unique demands of ORA, combined with the easy availability and capability of a new generation of large language model (LLM)-powered chatbots, create a perfect collision course for exposing sensitive patient information to private tech companies. This paper surveys how ORA intersects with internet associated privacy risks and offers a variety of multilevel suggestions for how these risks might be better mitigated.

OBJECTIVE: To describe the experiences and opinions of general practitioners (GPs) in England regarding patients having access to their full online GP health records.

DESIGN: Convenience sample, online survey.

PARTICIPANTS: 400 registered GPs in England.

MAIN OUTCOME MEASURES: Investigators measured GPs' experiences and opinions about online record access (ORA), including patient care and their practice.

RESULTS: A total of 400 GPs from all regions of England responded. A minority (130, 33%) believed ORA was a good idea. Most GPs believed a majority of patients would worry more (364, 91%) or find their GP records more confusing than helpful (338, 85%). Most GPs believed a majority of patients would find significant errors in their records (240, 60%), would better remember their care plan (280, 70%) and feel more in control of their care (243, 60%). The majority believed they will/already spend more time addressing patients' questions outside of consultations (357, 89%), that consultations will/already take significantly longer (322, 81%) and that they will be/already are less candid in their documentation (289, 72%) after ORA. Nearly two-thirds of GPs believed ORA would increase their litigation (246, 62%).

CONCLUSIONS: Similar to clinicians in other countries, GPs in our sample were sceptical of ORA, believing patients would worry more and find their records more confusing than helpful. Most GPs also believed the practice would exacerbate work burdens. However, the majority of GPs in this survey also agreed there were multiple benefits to patients having online access to their primary care health records. The findings of this survey also contribute to a growing body of contrastive research from countries where ORA is advanced, demonstrating clinicians are sceptical while studies indicate patients appear to derive multiple benefits.

Objectives: Following the launch of ChatGPT in November 2022, interest in large language model-powered chatbots has soared with increasing focus on the clinical potential of these tools. We sought to measure general practitioners' (GPs) current use of this new generation of chatbots to assist with any aspect of clinical practice in the UK.

Methods: An online survey was distributed to a non-probability sample of GPs registered with the clinician marketing service Doctors.net.uk. The study was launched as a monthly 'omnibus survey' which has a predetermined sample size of 1000 participants.

Results: 531 (53%) respondents were men, 544 (54%) were 46 years or older. 20% (205) reported using generative artificial intelligence (AI) tools in clinical practice; of those who answered affirmatively and were invited to clarify further, 29% (47) reported using these tools to generate documentation after patient appointments and 28% (45) to suggest a differential diagnosis.

Discussion: Administered a year after ChatGPT was launched, this is the largest survey we know of conducted into doctors' use of generative AI in clinical practice. Findings suggest that GPs may derive value from these tools, particularly with administrative tasks and to support clinical reasoning.

Conclusion: Despite a lack of guidance about these tools and unclear work policies, GPs report using generative AI to assist with their job. The medical community will need to find ways to both educate physicians and trainees and guide patients about the safe adoption of these tools.

Against the global need for increased access to mental services, health organisations are looking to technological advances to improve the delivery of care and lower costs. Since November 2022, with the public launch of OpenAI's ChatGPT, the field of generative artificial intelligence (AI) has received expanding attention. Although generative AI itself is not new, technical advances and the increased accessibility of large language models (LLMs) (eg, OpenAI's GPT-4 and Google's Bard) suggest use of these tools could be clinically significant. LLMs are an application of generative AI technology that can summarise and generate content based on training on vast data sets. Unlike search engines, which provide internet links in response to typed entries, chatbots that rely on generative language models can simulate dialogue that resembles human conversations. We examine the potential promise and the risks of using LLMs in mental healthcare today, focusing on their scope to impact mental healthcare, including global equity in the delivery of care. Although we caution that LLMs should not be used to disintermediate mental health clinicians, we signal how-if carefully implemented-in the long term these tools could reap benefits for patients and health professionals.

Patients’ online record access (ORA) is growing worldwide. In some countries, including the United States and Sweden, access is advanced with patients obtaining rapid access to their full records on the web including laboratory and test results, lists of prescribed medications, vaccinations, and even the very narrative reports written by clinicians (the latter, commonly referred to as “open notes”). In the United States, patient’s ORA is also available in a downloadable form for use with other apps. While survey studies have shown that some patients report many benefits from ORA, there remain challenges with implementation around writing clinical documentation that patients may now read. With ORA, the functionality of the record is evolving; it is no longer only an aide memoire for doctors but also a communication tool for patients. Studies suggest that clinicians are changing how they write documentation, inviting worries about accuracy and completeness. Other concerns include work burdens; while few objective studies have examined the impact of ORA on workload, some research suggests that clinicians are spending more time writing notes and answering queries related to patients’ records. Aimed at addressing some of these concerns, clinician and patient education strategies have been proposed. In this viewpoint paper, we explore these approaches and suggest another longer-term strategy: the use of generative artificial intelligence (AI) to support clinicians in documenting narrative summaries that patients will find easier to understand. Applied to narrative clinical documentation, we suggest that such approaches may significantly help preserve the accuracy of notes, strengthen writing clarity and signals of empathy and patient-centered care, and serve as a buffer against documentation work burdens. However, we also consider the current risks associated with existing generative AI. We emphasize that for this innovation to play a key role in ORA, the cocreation of clinical notes will be imperative. We also caution that clinicians will need to be supported in how to work alongside generative AI to optimize its considerable potential.

Following the launch of ChatGPT in November 2022, interest in large language model (LLM)-powered chatbots has surged with increasing focus on the clinical potential of these tools. Missing from this discussion, however, are the perspectives of physicians. The current study aimed to explore psychiatrists' experiences and opinions on this new generation of chatbots in mental health care. An online survey including both quantitative and qualitative responses was distributed to a non-probability sample of psychiatrists affiliated with the American Psychiatric Association. Findings revealed 44 % of psychiatrists had used OpenAI's ChatGPT-3.5 and 33 % had used GPT-4.0 "to assist with answering clinical questions." Administrative tasks were cited as a major benefit of these tools: 70 % somewhat agreed/agreed "documentation will be/is more efficient". Three in four psychiatrists (75 %) somewhat agreed/agreed "the majority of their patients will consult these tools before first seeing a doctor". Nine in ten somewhat agreed/agreed that clinicians need more support/training in understanding these tools. Open-ended responses reflected these opinions but respondents also expressed divergent opinions on the value of generative AI in clinical practice, including its impact on the future of the profession.

ORA is the concept of patients' access to clinical information, which has become more widespread worldwide. When patients are provided online record access (ORA) to their health records, concerns have been raised by healthcare professionals, especially when it comes to patients with mental health diagnoses. In the general population, positive aspects appear to outweigh the negative, yet limited research has so far explored the impact of ORA in mental healthcare. 

The overall aim of this thesis was to explore how patients experience ORA in mental healthcare through four studies: 1) a literature review aimed to explore the current literature on the experiences of ORA among mental healthcare patients, care partners, and healthcare professionals, 2) a document analysis combined with key stakeholder email interviews that aimed to explore to what extent ORA in mental healthcare has been implemented in Sweden including national and local policy regulations, 3) an online patient survey study aimed to understand mental healthcare patients' experiences with ORA in Sweden, Estonia, Finland, and Norway, and 4) an online patient survey study aimed to understand if and how patients with mental health conditions experiences of ORA differs from patients in other healthcare settings. 

More patients reported positive experiences with ORA in mental healthcare than negative experiences. Common benefits of ORA included, among others, a greater sense of control over their care, improved understanding of their mental health diagnosis, and better adherence to appointments. Despite patients' predominant positive experiences, only 17 out of 21 regions in Sweden offered ORA in mental healthcare in 2021. Additionally, many patients experienced errors and omissions and felt offended by the content of their health records. Mental healthcare patients experienced this at a higher rate than patients in other healthcare settings.

In conclusion, mental healthcare patients have higher rates of negative experiences of ORA compared to patients in other healthcare settings. However, patients' experiences of ORA are still predominantly positive among both patient groups. Yet, in 2021, only 17 regions offered patients ORA in mental healthcare. Denying mental healthcare patients ORA to protect them from negative experiences could instead increase stigma in this patient group.

Background: Previous research reports that patients with mental health conditions experience benefits, for example, increased empowerment and validation, from reading their patient-accessible electronic health records (PAEHRs). In mental health care (MHC), PAEHRs remain controversial, as health care professionals are concerned that patients may feel worried or offended by the content of the notes. Moreover, existing research has focused on specific mental health diagnoses, excluding the larger PAEHR userbase with experience in MHC.

Objective: The objective of this study is to establish if and how the experiences of patients with and those without MHC differ in using their PAEHRs by (1) comparing patient characteristics and differences in using the national patient portal between the 2 groups and (2) establishing group differences in the prevalence of negative experiences, for example, rates of errors, omissions, and offenses between the 2 groups.

Methods: Our analysis was performed on data from an online patient survey distributed through the Swedish national patient portal as part of our international research project, NORDeHEALTH. The respondents were patient users of the national patient portal 1177, aged 15 years or older, and categorized either as those with MHC experience or with any other health care experience (nonmental health care [non-MHC]). Patient characteristics such as gender, age, education, employment, and health status were gathered. Portal use characteristics included frequency of access, encouragement to read the record, and instances of positive and negative experiences. Negative experiences were further explored through rates of error, omission, and offense. The data were summarized through descriptive statistics. Group differences were analyzed through Pearson chi-square.

Results: Of the total sample (N=12,334), MHC respondents (n=3131) experienced errors (1586/3131, 50.65%, and non-MHC 3311/9203, 35.98%), omissions (1089/3131, 34.78%, and non-MHC 2427/9203, 26.37%) and offenses (1183/3131, 37.78%, and non-MHC 1616/9203, 17.56%) in the electronic health record at a higher rate than non-MHC respondents (n=9203). Respondents reported that the identified error (MHC 795/3131, 50.13%, and non-MHC 1366/9203, 41.26%) and omission (MHC 622/3131, 57.12%, and non-MHC 1329/9203, 54.76%) were “very important,” but most did nothing to correct them (MHC 792/3131, 41.29%, and non-MHC 1838/9203, 42.17%). Most of the respondents identified as women in both groups.

Conclusions: About 1 in 2 MHC patients identified an error in the record, and about 1 in 3 identified an omission, both at a much higher rate than in the non-MHC group. Patients with MHC also felt offended by the content of the notes more commonly (1 in 3 vs 1 in 6). These findings validate some of the worries expressed by health care professionals about providing patients with MHC with PAEHRs and highlight challenges with the documentation quality in the records.

Patient-Accessible Electronic Health Records (PAEHR) is particularly controversial in mental healthcare. We aim to explore if there is any association between patients with mental health conditions and the experience of someone demanding access to their PAEHR. A chi-square test showed a significant association between group belonging and experiences of someone demanding access to the PAEHR.

Patient-Accessible Electronic Health Records (PAEHR) are particularly disputed in mental healthcare. We aim to explore if there is any association between patients having a mental health condition and someone unwanted seeing their PAEHR. A chi-square test showed a statistically significant association between group belonging and experiences of someone unwanted seeing their PAEHR.

Background: Eye gaze devices can be a crucial tool for communication for individuals with severe motor disabilities as they only depend on the user’s eye movements to select a symbol, picture, word, or message. The implementation is complicated with success depending on many different factors.

Purpose: This thesis aims to summarize factors that facilitate successful implementations of eye gaze devices.

Method: To answer this question, a scoping review and a case description were conducted. The scoping review includes thirteen articles that discuss facilitating factors. The case description was conducted by interviewing the mother and teacher to a child that uses an eye gaze device for communication. The results were analyzed using the CFIR framework.

Results: Thirty-one themes that facilitate implementations could be identified in the review. Cooperation and collaboration among all people that are involved seems to be a clear facilitator. Further, everyone involved needs sufficient knowledge of eye gaze devices. Education and collegial learning are therefore considered important factors. In addition, the computer must be functional, easy to use, adaptable and durable. The implementation process must be well planned with clear goals and sufficient resources. The user of the device should be involved in the process and be motivated to use the computer. The findings from the case description were very similar to the findings of the review but emphasized the individuals involved in the implementation more than the review.

Conclusion: Eye gaze devices are an effective tool for communication for a wide range of users. Certain factors facilitate the often complicated implementation process. The main factors are support, collaborations, follow-up services, knowledge and skills, and engaging participants. Further research which focuses on the topic should be conducted as research is sparse. Possible directions could be to focus on barrier, on the larger context surrounding the implementation or on strategies to use facilitators in the planning of implementations.

Background 

Implementation within complex healthcare organisations is a topic that is not talked about enough. Medical technology is undergoing fast development and has revolutionised healthcare-systems over the last 50 years. Technical solutions have become a daily part of the healthcare sector. Why is it that some organisations introduce technology, and then later on abandon it?

Aim

The aim of this study is to understand which factors affect the abandonment of Philips CareEvent in a complex care environment (Neonatal Department), and which strategies could be used to overcome these barriers.

Method

This study was divided into 3 different stages: problem identification, analysis of complexity, and design of implementation strategies. Using interviews with five users for the empirical study, and analysing the results using the NASSS-framework for implementation, all three stages were fulfilled.

Results

This study found that the technology's value for the users and its software were the two most problematic domains within the NASSS-framework that had resulted in the abandonment of CareEvent. By analysing the barriers within the individual domains, strategies were created to overcome the barriers.

Conclusion

CareEvent is an example of medical technology that was not successfully adopted by caregivers despite filling a gap that must be filled to manage the increased workload. The NASSS-framework shows that despite CareEvents potential benefits for the organisation and its users, its abandonment is a result of its poor performance, lacking modernity and insufficient user-education. By implementing the technology using the concluded strategies in addition with an updated software, the chance of a successful reimplementation increases significantly.