Patient Experiences and Perceptions with Online Access to Electronic Health Records in Norway: Cross-Sectional Survey Comparing Mental Health and Somatic Patients (Preprint)

BACKGROUND Patient-accessible electronic health records (PAEHR) hold promises in empowering patients, but their impact may vary between mental healthcare and somatic care. Medical professionals and ethicists have expressed concerns about the potential challenges of PAEHR on patients, especially those receiving mental healthcare. OBJECTIVE This study aimed to investigate the experiences and perceptions of online access to electronic health records (EHR) among mental health and somatic patients, as well as to understand how these experiences and perceptions vary among patients receiving mental healthcare in different care locations. METHODS Using the Norwegian data from the NORDeHEALTH 2022 Patient Survey, we conducted a cross-sectional descriptive analysis of service use and perceptions of perceived mistakes, omissions, and offenses by mental health and somatic patients. Content analysis was used to analyze free-text responses to understand how patients experience the most serious mistakes in their EHR. RESULTS Among 9505 survey participants, we identified 2008 mental health patients (MHP) and 7086 somatic patients (SP). A higher proportion of MHP (69%) reported using PAEHR increased their trust in their healthcare providers, compared to SP (60%). However, a significantly higher percentage of MHP (48.6%) than SP (26.7%) reported perceiving mistakes in PAEHR, especially related to their diagnoses (20.8% MHP vs 15.2% SP). MHP also reported significantly higher odds of detecting omissions (37.7%) and being offended by what they read (36.3%) in their EHR compared to SP (26.3% and 11.7%, respectively). Both MHP and SP frequently perceived body weight and substance use descriptions as mistakes. Furthermore, patients receiving hospital inpatient care were more likely to detect mistakes (67.7%) and omissions (42.7%). In comparison, patients in outpatient and primary care detected mistakes (50.4% and 32%, respectively), omissions (40.1% and 29%, respectively) less frequently. Hospital inpatients also reported feeling more offended (58.5%) by what they read in their EHR, compared to patients in primary (21%) and outpatient care (34.3%). CONCLUSIONS Most MHP and SP respondents showed a positive attitude toward online access to EHR. However, MHPs, especially those receiving hospital inpatient care, were more critical towards their EHR compared to SP. While online access to EHR can provide patients with valuable information and support trust, it is important to consider the choice of clinical terminology and accurate, non-judgmental documentation, particularly for patients belonging to healthcare groups with unique sensitivities. CLINICALTRIAL Not applicable