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BACKGROUND Internationally, patient-accessible electronic health records (PAEHRs) are increasingly being implemented. Beyond reported benefits to patients, the innovation has prompted concerns among health care professionals (HCPs), including the possibility that access incurs a ‘dumbing down’ of clinical records. Currently no review has investigated empirical evidence of whether and how documentation changes after introducing PAEHRs. OBJECTIVE This paper presents the protocol for a scoping review examining potential subjective and objective changes in HCPs documentation after using PAEHRs. METHODS This scoping review will be carried out based on the framework of Arksey and O’Malley. Several databases will be used to conduct a literature search (APA PsycInfo, CINAHL, PubMed, Web of Science Core Collection). Authors will participate in screening identified papers, to explore the research questions: How do PAEHRs affect HCPs documentation practices? What subjective and objective changes to the clinical notes arise after patient access? Only studies that relate to actual usage experiences, and not merely prior expectations about PAEHRs, will be selected in the review. Data abstraction will include but will not be limited to publication type, publication year, country, sample characteristics, setting, study aim, research question, and conclusions. The Mixed Methods Appraisal Tool will be used to assess the quality of the studies included. RESULTS The results from this scoping review will be presented as a narrative synthesis structured along the key themes of the corpus of evidence. Additional data will be prepared in charts or tabular format. This scoping review protocol was first initiated by Uppsala University in collaboration with Brandenburg Medical School in January 2023. The results are expected to be presented in a scoping review in July 2023. They will be disseminated at scientific conferences and through publication in a peer-reviewed journal. CONCLUSIONS To our knowledge, this is the first scoping review that will address potential change in documentation after implementation of PAEHRs. The results can potentially help affirm or refute prior opinions and expectations among various stakeholders about the use of PAEHRs and thereby help to address uncertainties. They may help to provide guidance to clinicians in writing notes and thus have immediate practical relevance to care. In addition, the review will help to identify any substantive research gaps in this field of research. In the longer term, our findings may contribute to the development of shared documentation guidelines, which in turn are central to improving patient communication and safety.

BACKGROUND Mobile health (mHealth) apps have great potential to support the management of chronic conditions. Despite widespread acceptance of mHealth apps by the public, health care providers (HCPs) are reluctant to prescribe or recommend such apps to their patients. OBJECTIVE This study aimed to classify and evaluate interventions aimed at encouraging HCPs to prescribe mHealth apps. METHODS A systematic literature search was conducted to identify studies published from January 1, 2008, to August 5, 2022, using 4 electronic databases: MEDLINE, Scopus, CINAHL, and PsycINFO. We included studies that evaluated interventions encouraging HCPs to prescribe mHealth apps. Two review authors independently assessed the eligibility of the studies. The “National Institute of Health’s quality assessment tool for before-and-after (pretest-posttest design) studies with no control group” and “the mixed methods appraisal tool (MMAT)” were used to assess the methodological quality. Owing to high levels of heterogeneity between interventions, measures of practice change, specialties of HCPs, and modes of delivery, we conducted a qualitative analysis. We adopted the behavior change wheel as a framework for classifying the included interventions according to intervention functions. RESULTS In total, 11 studies were included in this review. Most of the studies reported positive findings, with improvements in a number of outcomes, including increased knowledge of mHealth apps among clinicians, improved self-efficacy or confidence in prescribing, and an increased number of mHealth app prescriptions. On the basis of the behavior change wheel, 9 studies reported elements of environmental restructuring such as providing HCPs with lists of apps, technological systems, time, and resources. Furthermore, 9 studies included elements of education, particularly workshops, class lectures, individual sessions with HCPs, videos, or toolkits. Furthermore, training was incorporated in 8 studies using case studies or scenarios or app appraisal tools. Coercion and restriction were not reported in any of the interventions included. The quality of the studies was high in relation to the clarity of aims, interventions, and outcomes but weaker in terms of sample size, power calculations, and duration of follow-up. CONCLUSIONS This study identified interventions to encourage app prescriptions by HCPs. Recommendations for future research should consider previously unexplored intervention functions such as restrictions and coercion. The findings of this review can help inform mHealth providers and policy makers regarding the key intervention strategies impacting mHealth prescriptions and assist them in making informed decisions to encourage this adoption.

BACKGROUND In 2022, NHS England announced plans to ensure that all adult primary care patients in England would have full online access to new data added to their general practitioner (GP) record. However, this plan has not yet been fully implemented. Since April 2020, the GP contract in England has already committed to offering patients full online record access on a prospective basis and on request. However, there has been limited research into UK GPs’ experiences and opinions about this practice innovation. OBJECTIVE This study aimed to explore the experiences and opinions of GPs in England about patients’ access to their full web-based health record, including clinicians’ free-text summaries of the consultation (so-called “open notes”). METHODS In March 2022, using a convenience sample, we administered a web-based mixed methods survey of 400 GPs in the United Kingdom to explore their experiences and opinions about the impact on patients and GPs’ practices to offer patients full online access to their health records. Participants were recruited using the clinician marketing service Doctors.net.uk from registered GPs currently working in England. We conducted a qualitative descriptive analysis of written responses (“comments”) to 4 open-ended questions embedded in a web-based questionnaire. RESULTS Of 400 GPs, 224 (56%) left comments that were classified into 4 major themes: increased strain on GP practices, the potential to harm patients, changes to documentation, and legal concerns. GPs believed that patient access would lead to extra work for them, reduced efficiency, and increased burnout. The participants also believed that access would increase patient anxiety and incur risks to patient safety. Experienced and perceived documentation changes included reduced candor and changes to record functionality. Anticipated legal concerns encompassed fears about increased litigation risks and lack of legal guidance to GPs about how to manage documentation that would be read by patients and potential third parties. CONCLUSIONS This study provides timely information on the views of GPs in England regarding patient access to their web-based health records. Overwhelmingly, GPs were skeptical about the benefits of access both for patients and to their practices. These views are similar to those expressed by clinicians in other countries, including Nordic countries and the United States before patient access. The survey was limited by the convenience sample, and it is not possible to infer that our sample was representative of the opinions of GPs in England. More extensive, qualitative research is required to understand the perspectives of patients in England after experiencing access to their web-based records. Finally, further research is needed to explore objective measures of the impact of patient access to their records on health outcomes, clinician workload, and changes to documentation.

Background Mobile health (mHealth) apps have great potential to support the management of chronic conditions. Despite widespread acceptance of mHealth apps by the public, health care providers (HCPs) are reluctant to prescribe or recommend such apps to their patients. Objective This study aimed to classify and evaluate interventions aimed at encouraging HCPs to prescribe mHealth apps. Methods A systematic literature search was conducted to identify studies published from January 1, 2008, to August 5, 2022, using 4 electronic databases: MEDLINE, Scopus, CINAHL, and PsycINFO. We included studies that evaluated interventions encouraging HCPs to prescribe mHealth apps. Two review authors independently assessed the eligibility of the studies. The “National Institute of Health’s quality assessment tool for before-and-after (pretest-posttest design) studies with no control group” and “the mixed methods appraisal tool (MMAT)” were used to assess the methodological quality. Owing to high levels of heterogeneity between interventions, measures of practice change, specialties of HCPs, and modes of delivery, we conducted a qualitative analysis. We adopted the behavior change wheel as a framework for classifying the included interventions according to intervention functions. Results In total, 11 studies were included in this review. Most of the studies reported positive findings, with improvements in a number of outcomes, including increased knowledge of mHealth apps among clinicians, improved self-efficacy or confidence in prescribing, and an increased number of mHealth app prescriptions. On the basis of the behavior change wheel, 9 studies reported elements of environmental restructuring such as providing HCPs with lists of apps, technological systems, time, and resources. Furthermore, 9 studies included elements of education, particularly workshops, class lectures, individual sessions with HCPs, videos, or toolkits. Furthermore, training was incorporated in 8 studies using case studies or scenarios or app appraisal tools. Coercion and restriction were not reported in any of the interventions included. The quality of the studies was high in relation to the clarity of aims, interventions, and outcomes but weaker in terms of sample size, power calculations, and duration of follow-up. Conclusions This study identified interventions to encourage app prescriptions by HCPs. Recommendations for future research should consider previously unexplored intervention functions such as restrictions and coercion. The findings of this review can help inform mHealth providers and policy makers regarding the key intervention strategies impacting mHealth prescriptions and assist them in making informed decisions to encourage this adoption.

UNSTRUCTURED This paper briefly outlines the history of the medical record and the factors contributing to the adoption of computerized records in primary care in the United Kingdom. It discusses how both paper-based and electronic health records have traditionally been used in the past and goes on to examine how enabling patients to access their own primary care record online is changing the form and function of the patient record. In addition, it looks at the evidence for the benefits of Web-based access and discusses some of the challenges faced in this transition. Finally, some suggestions are made regarding the future of the patient record and research questions that need to be addressed to help deepen our understanding of how they can be used more beneficially by both patients and clinicians.

BACKGROUND Improving cancer survival in the UK, despite recent significant gains, remains a huge challenge. This can be attributed to, at least in part, patient and diagnostic delays, when patients are unaware they are suffering from a cancerous symptom and therefore do not visit a general practitioner promptly and/or when general practitioners fail to investigate the symptom or refer promptly. To raise awareness of symptoms that may potentially be indicative of underlying cancer among members of the public a symptom-based risk assessment model (developed for medical practitioner use and currently only used by some UK general practitioners) was utilized to develop a risk assessment tool to be offered to the public in community settings. Such a tool could help individuals recognize a symptom, which may potentially indicate cancer, faster and reduce the time taken to visit to their general practitioner. In this paper we report results about the design and development of the REACT (Risk Estimation for Additional Cancer Testing) website, a tool to be used in a community setting allowing users to complete an online questionnaire and obtain personalized cancer symptom-based risk estimation. OBJECTIVE The objectives of this study are to evaluate (1) the acceptability of REACT among the public and health care practitioners, (2) the usability of the REACT website, (3) the presentation of personalized cancer risk on the website, and (4) potential approaches to adopt REACT into community health care services in the UK. METHODS Our research consisted of multiple stages involving members of the public (n=39) and health care practitioners (n=20) in the UK. Data were collected between June 2017 and January 2018. User views were collected by (1) the “think-aloud” approach when participants using the website were asked to talk about their perceptions and feelings in relation to the website, and (2) self-reporting of website experiences through open-ended questionnaires. Data collection and data analysis continued simultaneously, allowing for website iterations between different points of data collection. RESULTS The results demonstrate the need for such a tool. Participants suggest the best way to offer REACT is through a guided approach, with a health care practitioner (eg, pharmacist or National Health Service Health Check nurse) present during the process of risk evaluation. User feedback, which was generally consistent across members of public and health care practitioners, has been used to inform the development of the website. The most important aspects were: simplicity, ability to evaluate multiple cancers, content emphasizing an inviting community “feel,” use (when possible) of layperson language in the symptom screening questionnaire, and a robust and positive approach to cancer communication relying on visual risk representation both with affected individuals and the entire population at risk. CONCLUSIONS This study illustrates the benefits of involving public and stakeholders in developing and implementing a simple cancer symptom check tool within community. It also offers insights and design suggestions for user-friendly interfaces of similar health care Web-based services, especially those involving personalized risk estimation.