PONE-D-21-12855

“What’s the best way to document information concerning psychiatric patients? I just don't know” – a qualitative study about recording psychiatric patients notes in the era of electronic health records

PLOS ONE

Dear Dr. Chivilgina,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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The reviewers' aims are to be constructive and improve the paper. Do note that both reviewers ask for more details about the policy and practice context in Switzerland. They also raise concerns about your methods which you should address. 

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Please submit your revised manuscript by Sep 27 2021 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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We look forward to receiving your revised manuscript.

Kind regards,

Maria Berghs, PhD

Academic Editor

PLOS ONE

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Additional Editor Comments (if provided):

Both reviewers raise issues about the changed policy and practice context in Switzerland which is important to address. There are also some methodological concerns which require clarification.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: N/A

Reviewer #2: No

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: No

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This manuscript provides a qualitative analysis of the Electronic Healthcare Record system used in Switzerland. The article is of great interest, and my comments are intended to improve the manuscript. Overall, the qualitative approach is novel, and provides a new perspective on the use of EHR; but more work is required to improve the narrative and framing of the results. My comments are listed below:

1. The abstract requires significant modification, it is too long and includes citations. It should be a short reflection on the rationale for the study, the aim, the method utilised and the main findings.

2. The introduction focuses on the introduction of EHR; however, it fails to provide any detail on how EHR are formed and managed in Switzerland. Does the National Government specify how EHR are organised, or is it at a regional or local level? As a reader, understanding ‘what’ the EHR is in Switzerland helps frame your findings. Another interesting element would be to provide some statistics on its use across Switzerland.

3. The authors state that EHR have been used in Switzerland for a ‘long time’ (be helpful to provide a timeframe); therefore, it is appropriate to use the study framing as ‘EHR implementation’? The study does not reflect on how EHR was implemented, but on its utility, usability and acceptability. I would encourage the authors to consider this point. If they still believe implementation is the correct phrasing, a definition would be useful.

4. The methods section is brief considering the study scope, it would be useful to expand more on the theoretical underpinning of the qualitative analysis. Further, how did the authors determine data saturation? Was a continuous analytical approach undertaken?

5. I have no criticism of the results. Thought-out and detailed.

6. The main limitation of the paper is its lack of ambition in synthesis in the discussion. It would be useful to describe how the EHR in Switzerland compares with other Nation’s EHR systems. Can any lessons be learnt from other EHR systems? And in return, what can other EHR systems adopt from the findings of this study?

Reviewer #2: This manuscript details a qualitative analysis of interviews with Swiss psychiatrists regarding several issues surrounding electronic health records. The authors faithfully report interview excerpts and do a good job on the whole of categorizing recurring themes and attitudes towards psychiatric EHR use. Below are comments that I feel would improve the manuscript:

1. The text is well-written, but I feel the organization could be clarified and improved. For example the end of the results section states "participants suggested solutions listed below", but is then followed by several pages that are mostly psychiatrist concerns/challenges (until Table 3. Recommendations). To my reading, the sections 1-5 did not follow a common theme and should be reorganized, potentially with more descriptive headings or sub-headings.

2. Some of the headings also did not make sense to me (like "3. Personal-self (patient)").

3. To my reading, some of the issues treated by the authors as distinct seemed to overlap. For example, in the Vignette: the issue of "saving diagnoses in EHR for improving patient care by sharing amounts providers" and "medical collegiality" seem almost equivalent.

4. Given the statement that all Swiss hospitals should implement EPD by 2021 (we are currently more than halfway through 2021), I think the authors should spend more time discussing whether their interviews and findings are still relevant given this new system that appears to solve many existing challenges. It would have been nice to discuss EPD in the interviews since it appears to be a large paradigm shift.

5. Some minor typos throughout: at least one instance of "HER" (should be "EHR)", "hack of psychotherapy records" in final paragraph before the Limitations (should be "lack"), capitalizing "Skype" in results section, etc.

6. The authors should check for consistency in their methods and be as detailed as possible. In the first paragraph of the Methods section, they say 16 interviews were carried out face-to-face and 4 interviews were performed online via Skype. In the Results section, they state that the 20 interviews took place in person, "over the phone", or over Skype.

7. The paper is mostly insertions of things the psychiatrists said during the interviews. In "1. Strengths of the use of EHR...", I appreciated the summarization of how many interviewees mentioned certain themes - I think the authors should repeat this for the other results sections.

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Reviewer #1: No

Reviewer #2: No

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PONE-D-21-12855R1“What’s the best way to document information concerning psychiatric patients? I just don't know” – a qualitative study about recording psychiatric patients notes in the era of electronic health recordsPLOS ONE

Dear Dr. Chivilgina,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please submit your revised manuscript by Jan 03 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Maria Berghs, PhD

Academic Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

Additional Editor Comments (if provided):

The article is not of publishable standard. This has nothing to do with the data nor methods but the presentation of the findings and formatting. So, I hope you will attend to these issues. One reviewer has advised to accept but before we can accept it, I would like you to ensure that, for example, when presenting your findings that you signpost to the reader what these are.. This is why the headings did not make sense for the second reviewer. who requested major revisions. So, I would insert a short paragraph before the presentation of the findings, signposting the main themes (your headings) and explain that you will discuss these in turn. The results section with table seems to correspond to your methods (how many people participated in your research/who/sample) and the findings are about your themes that you found in your data analysis. The way it is currently laid out is confusing to the reader.

I would also encourage you to look at some other papers in the journal and see what the conventions are when sharing quotations and how they signpost. I would advise you to signpost more and also present quotations likewise so that it is the voices of your participants that are highlighted: For example, here the voice is first: 

“Many patients are telling me "I'm going to say that. But please don't write it. Or please don't make any notes of it". They wanted to keep it between the two of us. I think because there is a legitimate fear” (P14, HP,F)

At the moment , in places, your quotations are lists rather than ethical analysis of what people are saying. Could you use fewer quotations or format so we can see them clearer? The section on Trust and Transparency is good.

Again, before your discussion it might be useful to signpost to the reader what the main points will be that you are discussing.

Please check your first reference and that you do not have to mention an author?

The conflicts of interests section goes at the end of an article and not before the conclusion.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #2: Partly

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #2: N/A

********** 

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #2: No

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #2: (No Response)

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #2: The authors have satisfactorily addressed all comments. I now recommend this manuscript for publication.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #2: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

“What’s the best way to document information concerning psychiatric patients? I just don't know” – a qualitative study about recording psychiatric patients notes in the era of electronic health records

PONE-D-21-12855R2

Dear Dr. Chivilgina,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Maria Berghs, PhD

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Thank-you for your hard work and patience with this article.

Reviewers' comments: