Near-wins in the pursuit of quality: does transparency matter if no one is looking?

Bell SK, DesRoches C. Near-wins in the pursuit of quality: does transparency matter if no one is looking? BMJ Quality & Safety. Published online October 22, 2025:bmjqs-2025-019394. doi:https://doi.org/10.1136/bmjqs-2025-019394 ‌

https://doi.org/10.1136/bmjqs-2025-019394

Bell and DesRoches’ editorial traces open notes from radical idea to federal mandate, asking: does transparency matter if patients can’t access or understand their notes? They argue that while the 21st Century Cures Act made notes legally available, many patients remain unaware they exist or face barriers to portal registration—making today’s open notes a “near-win.”

Research shows note-reading patients demonstrate greater medication adherence, better visit preparation, and improved completion of diagnostic tests. Notably, older, sicker, and historically marginalized patients report feeling better about their doctors after reading notes, experiencing the relational power of transparency. Patients also identify documentation errors and safety blind spots clinicians miss.

Yet challenges persist: templated notes alienate patients, privacy concerns remain, and most critically, transparency alone doesn’t generate improvements—patients must actually access and comprehend their notes. The authors highlight Sara Riggare’s insight that patients spend 8,760 hours annually managing health independently versus one hour with clinicians, positioning notes as crucial tools bridging care gaps.

Looking forward, AI promises tailored note summaries and co-generated documentation, but risks include perpetuating bias, prioritizing billing over patient values, and widening digital divides. The authors call for genuine patient partnership in tool development to achieve not just transparency success, but quality mastery.