Whether you’re learning about open notes and how notes can help you, getting ready to start reading notes, or are an experienced user of notes, here are some answers to questions people often ask:

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Between now and the April 5 federal mandate of the implementation of the 21st Century Cures Act Info Blocking Rule, we’re answering your top questions about the open notes aspect of the rule.
In several studies of how open notes affect the way doctors prepare notes, the majority report they don’t change the way they write their notes. But many clinicians experienced in sharing notes report their writing does change over time, feeling overall that it becomes more valuable, certainly to patients. Few report “dumbing down” their language, but they find themselves using fewer abbreviations and trying to avoid language that could appear judgmental to patients. Some report modulating their practice such that they become “teaching notes.”
In general, patients do not expect doctors to write notes in layperson language, and more than 90% in one large study report understanding their notes well. Patients not bothered by terms they don’t understand, and they are happy to research terms. They feel reading notes helps them prepare more focused questions for clinicians. Overall, they express considerable enthusiasm for having a window into more information about their health.
Resources:
Tip Sheet: Suggestions for implementing open notes in clinical practice, OpenNotes.org
How to write an open note for patients, CT Lin, MD
Under the new federal mandate, in certain specified situations information can be blocked (or “hidden”) from patient access on online portals—these are called Exceptions. As examples, clinicians can block notes
• If they believe a patient will harm another person or themselves as a result of reading a note
• If they need to protect the security of another person’s electronic health information (e.g., a mother’s health information in a child’s record)
Unless one of the Exceptions applies, clinical notes must not be blocked. Details about exceptions are outlined at HealthIT.gov.
Learn more about how the Cures Rule applies to open notes.
We’ve spent more than 10 years studying the effects of open visit notes on patients, care partners and clinicians. Time and again, studies show that open, transparent communication through visit notes are a good thing, across all demographics, and the majority of clinicians with experience with open notes feel it is a good idea and would recommend it to colleagues
This website serves as the “library” of the OpenNotes movement. You are likely to find many answers to your questions if you take a little time, review a newsletter, or sign in to one of our past or future webinars. In addition, several places on this website detail research and best practices about open notes in special circumstances. Check them out.
In advance of open notes, clinical staff more often than not anticipate significant changes to workflow and workload. However, time after time we hear such worries proved misplaced. Among the >260 organizations that implemented open notes prior to November 2020, not one reported a significant increase in visit time with patients or in e-mail traffic. In fact, some reported a decrease in e-mail, as patients are able to resolve confusion or forgetfulness by reading their notes.
Patients generally respect their provider’s time, and most doctors report little, if any, impact from patients on their daily practice. Indeed, once underway, many report forgetting they were participating in a new intervention. But in recent surveys, about one in three doctors report taking somewhat more time to write notes, with fewer than 10% reporting taking much more time. We do not have independent verification of such reports. However, more than a few tell us that initially they took more time, but once settled in with this new transparency, they prepare their notes with the same efficiency as in the past.
Resources:
In numerous studies across multiple specialties, the majority of patients (93-99%) reported that reviewing their notes made them feel the same or better about their doctor, and more than half of the doctors participating reported that sharing notes led to improved patient satisfaction and trust.
Evidence is mounting: Sharing notes with patients can lead to better communication, more collaborative decision-making and stronger relationships. Perhaps most importantly, open notes can be powerful tools for enhancing patient engagement, and considerable research demonstrates that engaged patients have better outcomes.
Learn how open notes adds to the therapeutic appliance, builds stronger relationships and improves patient engagement.
Open notes can assist and support family, friends, and others who are care partners and caregivers. Forty percent of patients who read notes report sharing them with others, primarily family members. Shared notes help care partners manage the health needs of the people in their care, including scheduling visits, reconciling medication lists, and following through on a host of recommendations.
Importantly, transparent communication may be a powerful way to diminish stress and morbidity in the care partners themselves. In a recent study, care partners reported benefits from note sharing similar to those reported by patients. Additionally, care partner access to notes can serve as a bridge for patients with limited English, low health literacy, and those without computers or access to the Internet.
Enhancing mechanisms that offer ready proxy access to portals for care partners is clearly an important national work-in-progress. OpenNotes is engaged in research focusing on best practices and enhancing processes that meet the needs both of the individual patients and those caring for them.
During COVID
Care partners are often under enormous stress, and the Covid-19 pandemic has magnified virtually all the contributing factors. Transparent communication can play a large role in diminishing burdens care partners themselves experience.
View the Care partner toolkit to learn more.
Improved adherence to medications may be the most important clinical benefit transparent communication can confer. In a study published in 2019, a majority of patients reported that open notes improved their understanding of why and how to take their medications, and one out of six patients surveyed reported that open notes led them to adhere to their regimen more closely. Given that poor adherence to medications may cost the health care system as much as $300 billion dollars annually, this finding has striking implications.
In interviews and focus groups with patients and families, we have repeatedly heard anecdotes supporting these survey findings. Moreover, a study by the Geisinger Center for Health Research found that patients in practices offering access to notes were more likely to fill their prescriptions for blood pressure medication than were those in practices whose notes remained hidden.
Resources:
The digital divide persists. Individuals who do not usually speak English at home, have less than high school education, are nonwhite, older, or Hispanic are not as likely to register on patient portals and are therefore less likely to read their notes. However, in repeated studies, when these patients do get to read notes, they are those most likely to report benefits from note reading. Safety net institutions around the country, both hospitals and community-based health centers, have been joining the OpenNotes movement, and we receive many positive reports.
Resources:
Open Notes for Health Professionals
Navigating patient portals remains a challenge for patients. Patients often give up before finding what they need, and this includes finding notes. Health systems that make it easy for patients to access notes find that more patients choose to register for their portals and use open notes to full advantage.
Resources:
OpenNotes white paper: Implementing Open Notes: Improving patient access to notes on portals
OpenNotes Grand Rounds recording: Improving Portals for a Better Patient Experience
Most patients do not know that their notes are available for review. Indeed, more than a few don’t realize that clinicians write notes following visits.
Patients benefit from messaging about notes and your portal through multiple platforms, including posters, handouts, social media, email, text messaging, and person to person communication by members of the health team. A study of two health organizations, one with an electronic reminder system, and one that stopped reminding patients half way during a 2-year period, showed that patients viewed their notes far more often when accompanied by an email notification.
If you have an active Patient and Family Advisory Council (PFAC), we strongly recommend involving them in developing your communication materials about open notes.
Resources:
OpenNotes Communications Toolkit
OpenNotes Patient-Family Advisory Council Toolkit
OpenNotes Grand Rounds recording: Improving Portals for a Better Patient Experience
We’ve spent over 10 years studying the effects of open visit notes on patients, care partners and clinicians in a broad variety of ambulatory care settings. Time and again, studies show that open, transparent communication through visit notes are a good thing, across all demographics, and clinicians think open notes are a good idea.
Now, as a result of the Interoperability and Information Blocking Rule, all progress notes must be shared—including inpatient and emergency department notes. Since the focus of investigators has primarily been on office practice, we know little about the effects of sharing notes on inpatient services and in emergency rooms.
But there is developing experience. Learn with us: Tune-in to this Webinar case study about Open Inpatient Notes at UC San Diego Health on March 23.
Resource:
We study the effects of open visit notes on patients, clinicians, and care partners. We have not addressed test results released to patients through online portals. But there is considerable experience nationally with this issue. Using portals, some systems have invited patients to review such results for more than 20 years. These practices are quite variable. Some release everything the minute results are available. Others have selective embargoes…a CT scan or MRI may be published 48 hours later; pathology reports may be “blocked” for 2 weeks, and so on.
Now, with the Interoperability & Information Blocking Rule, we are hearing some consternation about the timing of the release of test results. Ideally, individual patients could specify their own processes. In our informal discussions with patients, some want immediate availability; others prefer to hear first from their clinicians, particularly if bad news could be on the horizon.
We know of little empirical evidence quantifying such divergent views. Our sense is that “embargoes” are in flux, and some EHR vendors are also enabling clinicians to make case by case decisions to block or delay results, hopefully with the individual patient’s needs and desires firmly in mind. This may become an example of where the “letter of the law” specifies one thing, and evolving “common law” heads in a somewhat different direction.
Ideally, patients should have a choice in the information they want to see, and when they want to see it. Overall, we are learning patients want to be in more control of their health information. This Information Blocking rule is an opportunity to invest in research and technologies that allow people to set their own information preferences. As portals and apps evolve in the future, offering patients more and more options will be part of a rapidly changing landscape of care.
Whether you’re learning about open notes and how notes can help you, getting ready to start reading notes, or are an experienced user of notes, here are some answers to questions people often ask:
After office or tele-visits, doctors, nurses and other health care providers write notes that summarize important information about you. These notes become a part of your medical record. And when a note is shared with you, it becomes an "open note." It may include:
How notes look depends on many things: who writes the note, the kind of visit, where you get care, etc. Sometimes the notes are short. Others include a complete description of the visit and may also include additional details about your health, such as past problems or test results. And due to various rules and regulations, some may include information that doesn’t seem very relevant.
Your note may have medical language that’s not easy to understand. You can find a lot on the Internet, but try to make sure it comes from a reliable source. View this list of common abbreviations to help you with medical terms. If you have questions, write them down. Follow through, whether with a friend, your doctor, or any source you trust.
Note reading may not be right for everyone. Follow your instincts. For some people, just knowing that the notes are available is enough. Thousands of patients report that the benefits from reading notes are much greater than the risks. In fact, reading notes often builds or reinforces your trust in those taking care of you. And studies show that very few people report feeling harmed by what they read.
By federal law, you have the legal right to receive and review all of your medical records, including the notes. Starting April 15, 2021, most providers will be required by law to make them available by electronic means, such as through secure Internet patient portals. There are a few exceptions, but we expect the vast majority of notes will become available in the future, no matter what health condition you may have.
If your notes are not yet online, you can always ask for a paper copy.
Possible reasons include:
If it’s serious—something that could affect your care urgently—contact the office of the health care provider who wrote the note.
For other mistakes or inaccuracies, bring them to your medical team’s attention, particularly if you think correcting the note will affect your current or future care. Your healthcare provider’s office will have a process for helping ensure accuracy.
It’s important to know that open notes do not change the entirely confidential relationship you have with your health care providers. They can share your information only with health professionals who care for you and with some administrative personnel who also have the legal and ethical right to see your personal health information.
On the other hand, the information in your records is about you, and you can choose to share it with others. With ready access to your notes, it’s much easier to share your medical information with a care partner, family member, or others—but only if you choose.
To help ensure your privacy when using an online patient portal, remember to:
OpenNotes is a not-for-profit international movement started in 2009 by health professionals at Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, Massachusetts. It is supported entirely by grants from private foundations, gifts from donors, and federal research grants. OpenNotes does not develop or sell software or commercial products. Its staff includes doctors, nurses, mental health professionals, social scientists, and patients and their care partners. Those working with OpenNotes have two principal activities: They urge health care providers and systems to share notes with patients and care partners efficiently and actively, and they study what happens as a result.
Learn how to cite OpenNotes in your work.
We are funded entirely by non-commercial grants, philanthropy, and supporters like you. Consider a tax-deductible gift of any size to support the OpenNotes movement. Your entire donation will go to OpenNotes .
We're funded by grants, philanthropy, and supporters like you. Your entire tax-deductible donation will go to spreading the OpenNotes movement.