Understanding Patient-Reported Offenses in Electronic Health Records: Cross-Sectional Mixed Methods Survey.

Area of Science:

• Health Informatics
• Patient Experience
• Clinical Communication

Background:

• Patient access to electronic health records (EHRs) enhances engagement but can lead to negative experiences.
• Healthcare professionals require guidance on writing EHRs to avoid offending patients, particularly those with mental health conditions.
• Previous research has often focused on specific patient groups, limiting understanding of cross-group differences in EHR-related offense.

Purpose of the Study:

• To determine if specific patient groups are more likely to be offended by EHR content.
• To identify information within EHRs that patients perceive as offensive.
• To compare patient offense across diverse groups using a mixed-methods approach.

Main Methods:

• A cross-sectional, mixed-methods survey was administered via the Finnish national patient portal.
• 4681 respondents were categorized into groups based on care received: mental health, cancer, other conditions, or no care.
• Multivariate logistic regression and inductive content analysis were used to assess offense and identify offensive content.

Main Results:

• Patients receiving mental health care (25.4%) or combined mental health and cancer care (23.1%) reported higher offense rates.
• Errors, disrespectful language, and unnecessary information were key reasons for offense.
• Mental health patients more frequently found unnecessary information and professional opinions offensive.

Conclusions:

• Certain patient groups, particularly those with mental health or combined cancer/mental health care, are more susceptible to offense from EHR content.
• Healthcare professionals should be educated on neutral EHR note-writing, avoiding potentially offensive language and topics.
• Improving EHR quality through careful writing can strengthen patient-provider relationships.