Understanding Patient-Reported Offenses in Electronic Health Records: Cross-Sectional Mixed Methods Survey
Clinical Snapshot
PICO Framework
| P — Population | 4,681 patients accessing their electronic health records via Finnish national patient portal, categorized into mental health care, cancer care, other conditions, and no care groups |
| I — Intervention | Access to and reading of electronic health records |
| C — Comparator | Different patient groups (mental health vs cancer vs other conditions vs no care) |
| O — Outcomes | Patient-reported offense when reading EHRs, types of offensive content identified |
Bottom Line
This large Finnish cross-sectional study demonstrates that patients receiving mental health care are significantly more likely to feel offended by content in their electronic health records compared to other patient groups (25.4% vs 11.6%). The most common sources of offense were errors, disrespectful language, and unnecessary information. Mental health patients specifically reported offense at professional opinions and word choices. While the absolute numbers affected remain relatively small, the findings highlight the need for clinician education on neutral, respectful documentation practices, particularly when caring for vulnerable populations. Australian clinicians should consider these findings when documenting in My Health Record or practice management systems, ensuring language remains professional, factual, and patient-centered. The study's mixed-methods approach and large sample provide robust evidence for developing documentation guidelines that preserve the therapeutic relationship while maintaining clinical accuracy.
Key Findings
P Value: P<0.001
Effect Size: Mental health patients 25.4% vs other conditions 11.6% offense rate
Primary Outcome: Patient-reported offense when reading EHRs
Nnt Or Sensitivity: Number needed to harm: approximately 7 mental health patients vs 9 other patients to experience one offense
Confidence Interval: OR 0.37 (95% CI 0.29-0.46) for other conditions vs mental health care
Clinical Application
Highly feasible - requires clinician education on neutral documentation practices Relevant to My Health Record and private practice EHR systems; aligns with RACGP guidelines on patient-centered communication All patients with EHR access, particularly those with mental health conditions
Abstract
BACKGROUND: Patients' access to their electronic health record (EHR) supports their participation and satisfaction with care. Despite the benefits, some patients have been upset after reading their EHR. Additionally, health care professionals are concerned that patients, particularly those with mental health conditions, may be offended, and they have expressed a need for further guidelines on how to write EHRs. Experiences among various patient groups are essential to support the relationship between patients and professionals. However, prior studies have often focused on single patient groups or specific clinical contexts, leaving a limited understanding of differences across multiple patient groups. OBJECTIVE: This study aimed to determine whether certain patient groups are more likely to feel offended while reading their EHRs and which information is perceived as offensive and to provide a comparison across multiple patient groups using a mixed methods approach. METHODS: A cross-sectional survey was conducted via the Finnish national patient portal using a web-based patient survey, adopting a mixed methods approach. The survey included multiple-choice and open-ended questions. The total sample comprised 4681 respondents. The survey respondents were placed into 4 patient groups: those who had received care for mental health, cancer, or other conditions and those who had received no care. Associations between the type of care and patients who felt offended were estimated using multivariate binary logistic regression. Inductive content analysis (n=502) was conducted to identify information perceived as offensive in the EHR. RESULTS: The patients who had received mental health care (166/654, 25.4%) or cancer and mental health care (9/39, 23.1%) were more likely to be offended by information in their EHR compared to the other groups (cancer care: 37/375, 9.9%; other conditions care: 383/3316, 11.6%; no care: 22/206, 10.7%; other conditions care: odds ratio 0.37, 95% CI 0.29-0.46; P<.001; model A). Additionally, female patients, those with bad or very bad health conditions, and patients with bachelor's or master's degrees were significantly more likely to feel offended. Errors, the health care professionals' disrespectful language, and perceived unnecessary information were the most frequently mentioned reasons for being offended. Patients with mental health care reported more often that unnecessary information and professionals' opinions and word choices were experienced as offensive compared to other patients. CONCLUSIONS: This study contributes new knowledge by identifying differences across multiple patient groups. Although a minority of patients felt offended by their EHR, health care professionals should consider that some patients, particularly those who have received mental health care or cancer and mental health care, may be offended by specific information or word choices in their EHRs. To address this, health care professionals should receive education on how to write their notes in a neutral tone and avoid potentially offensive topics. Improving the quality of EHRs could strengthen the relationship between patients and professionals.
References
- 1.Simola, S., Kujala, S., Cajander, Å., Kharko, A., Kane, B., Wang, B., Åhlfeldt, R. M., & Hägglund, M. (2026). Understanding Patient-Reported Offenses in Electronic Health Records: Cross-Sectional Mixed Methods Survey. Journal of Medical Internet Research. https://doi.org/10.2196/86178
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