The Road Toward Fully Transparent Medical Records

Patient accessing OpenNotes on home computer.

Patients are engaged and participate in their care when they can view their medical records.

The Issue:

With the increasing use of electronic health records (EHRs), patients have more access to their lab and medical records. What is less often seen by patients, however, are the notes doctors enter in the medical record. The Robert Wood Johnson Foundation-funded OpenNotes initiative sought to find out how patients would use and feel about open access to doctors’ notes. Others now are experimenting with OpenNotes and exploring how they might change doctors’ practices.

Key Findings

  • Doctors aware that patients and families might view notes are taking care to choose their words, especially when there is suspicion of cancer. EHR templates prevent challenges when communicating nuances.

  • Some clinicians, concerned that OpenNotes will become “watered down” and obscure medical information, want to set preferences about what patients can see.

  • Patients also are seeking more control over access to their medical records and are concerned about privacy issues and clinical notes related to mental health, substance abuse, or other sensitive topics.


OpenNotes, mostly used by ambulatory care doctors, could expand to cover other practitioners (nurse practitioners, physician assistants, case managers) and settings (inpatient hospital and long-term care).

OpenNotes, a grantee of the Robert Wood Johnson Foundation, was developed to demonstrate and evaluate the impact on both patients and clinicians of fully sharing (through an electronic patient portal) all encounter notes between patients and their primary care providers.