Adapting to transparent medical records: international experience with "open notes"

From 30 November 2022, patients in England who sign up for an online health service, such as the NHS App, should have access to their full primary care health record prospectively and by default. Every new entry made in the primary care record will be immediately visible to patients, including the free text consultation entries (commonly referred to as 'open notes’). Clinicians are understandably concerned about this radical change in practice, fearing additional burdens for their work, an onslaught of calls or emails from anxious or confused patients, as well as potential risks to patients’ safety. With this change, the functionality of the clinical record is also evolving. No longer will the medical record serve primarily as an aide memoire or communication tool for clinicians, or as a billing device (as in the US), it will transform increasingly into a central form of communication among clinicians, patients and, in many cases, their care partners. In this article, as a team of primary care physicians (BM, TD), a patient (LS), health services researchers (TD, BM, GD, CB), social scientists (BM, GD), and a philosopher (CB), we draw on ongoing qualitative work [by BM, GD, and CB] among primary care staff in England combining it with evidence derived from countries where open notes are advanced (see Table 1) to summarize concerns and offer suggestions for how clinicians may consider changing their practice.