title: Trust in Mental Health Clinicians Among Patients Who Access Clinical Notes Online.
abstract: OBJECTIVE
  This study explored patient perspectives of how online access to clinical notes (OpenNotes) within the Veterans Affairs (VA) health care system may affect patients' relationships with their mental health clinicians.
  
  
  METHODS
  Semistructured qualitative interviews were conducted with 28 patients receiving VA mental health care who had accessed OpenNotes. Transcripts were coded and analyzed with a constant comparative approach.
  
  
  RESULTS
  Respondents consistently reported that patient-clinician relationships-feelings of trust in particular-are critical to the therapeutic process and that reading clinical notes strengthens or strains patients' trust in mental health clinicians. Perceptions of transparency and respect as conveyed in notes were central to maintaining trust.
  
  
  CONCLUSIONS
  Findings suggest that ensuring consistency between what occurs during appointments and what appears in clinical notes, as well as highlighting patient individuality and strengths in notes, may help engender patient trust and avoid negative consequences of OpenNotes in mental health care.
authors.affiliation: Dr. Cromer, Dr. Denneson, Ms. Pisciotta, Ms. Williams, and Dr. Dobscha are with the Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon. Dr. Denneson and Dr. Dobscha are also with the Department of Psychiatry, Oregon Health and Science University, Portland. Dr. Woods is with the VA Connected Health Office, Veterans Affairs Maine Healthcare System, Augusta, Maine.
authors.forename: Risa
authors.initials: R
authors.lastname: Cromer
authors.affiliation: Dr. Cromer, Dr. Denneson, Ms. Pisciotta, Ms. Williams, and Dr. Dobscha are with the Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon. Dr. Denneson and Dr. Dobscha are also with the Department of Psychiatry, Oregon Health and Science University, Portland. Dr. Woods is with the VA Connected Health Office, Veterans Affairs Maine Healthcare System, Augusta, Maine.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Denneson
authors.affiliation: Dr. Cromer, Dr. Denneson, Ms. Pisciotta, Ms. Williams, and Dr. Dobscha are with the Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon. Dr. Denneson and Dr. Dobscha are also with the Department of Psychiatry, Oregon Health and Science University, Portland. Dr. Woods is with the VA Connected Health Office, Veterans Affairs Maine Healthcare System, Augusta, Maine.
authors.forename: Maura
authors.initials: M
authors.lastname: Pisciotta
authors.affiliation: Dr. Cromer, Dr. Denneson, Ms. Pisciotta, Ms. Williams, and Dr. Dobscha are with the Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon. Dr. Denneson and Dr. Dobscha are also with the Department of Psychiatry, Oregon Health and Science University, Portland. Dr. Woods is with the VA Connected Health Office, Veterans Affairs Maine Healthcare System, Augusta, Maine.
authors.forename: Holly
authors.initials: H
authors.lastname: Williams
authors.affiliation: Dr. Cromer, Dr. Denneson, Ms. Pisciotta, Ms. Williams, and Dr. Dobscha are with the Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon. Dr. Denneson and Dr. Dobscha are also with the Department of Psychiatry, Oregon Health and Science University, Portland. Dr. Woods is with the VA Connected Health Office, Veterans Affairs Maine Healthcare System, Augusta, Maine.
authors.forename: Susan
authors.initials: S
authors.lastname: Woods
authors.affiliation: Dr. Cromer, Dr. Denneson, Ms. Pisciotta, Ms. Williams, and Dr. Dobscha are with the Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System, Portland, Oregon. Dr. Denneson and Dr. Dobscha are also with the Department of Psychiatry, Oregon Health and Science University, Portland. Dr. Woods is with the VA Connected Health Office, Veterans Affairs Maine Healthcare System, Augusta, Maine.
authors.forename: Steven K
authors.initials: SK
authors.lastname: Dobscha
mesh_terms: D000328:Adult; D000368:Aged; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000592:standards*; D008875:Middle Aged; D011369:Professional-Patient Relations; D036301:Qualitative Research; D035502:Trust; D014481:United States; D014493:United States Department of Veterans Affairs
keywords: Electronic Health Records; Mental Health; Patient perceptions; Veterans