Predictors of viewing progress notes among users of VA's electronic health portal who receive mental health care

Objective: Consistent with the OpenNotes movement, the Veterans Health Administration (VHA) offers patients online access to their clinical notes through the Blue Button feature in its electronic patient health portal, My HealtheVet. We identified demographic, diagnostic, and knowledge-related predictors of viewing clinical notes among veterans receiving VHA mental health care who recently used My HealtheVet. Materials and Methods: Three hundred and thirty-eight patients receiving mental health care from 1 VHA medical center who had logged into My HealtheVet in the prior 6 months completed self-report questionnaires assessing their viewing of clinical notes. Additional data were extracted from VHA's Patient Care Database. Multivariable logistic regression was used to examine predictors of viewing notes. Results: Fifty percent of respondents reported having read their notes. In the final multivariable model, post-traumatic stress disorder (PTSD) diagnosis [odds ratio (OR) = 2.30 (1.31-4.07)], speaking with their mental health clinician about their ability to view notes [OR=3.84 (1.69-8.72)], and being very or extremely confident in understanding the purpose and uses of Blue Button [OR=9.80 (2.23-43.07) and OR=13.36 (2.74-65.20), respectively] were associated with viewing notes. Discussion: Patient recall of mental health clinicians speaking to them about their ability to view notes, and confidence in understanding the use and purposes of Blue Button, were stronger predictors of viewing notes than demographic variables. PTSD diagnosis was the only clinical characteristic associated with viewing notes. Conclusion: The findings support the value of mental health clinicians openly discussing the availability of notes with patients if they wish to help them take advantage of their potential benefits.