Intended for healthcare professionals

Practice Practice Pointer

Adapting to transparent medical records: international experience with “open notes”

BMJ 2022; 379 doi: (Published 21 November 2022) Cite this as: BMJ 2022;379:e069861
  1. Charlotte Blease, Keane scholar1,
  2. Brian McMillan, NIHR advanced fellow2,
  3. Liz Salmi, communications and patient initiatives director1,
  4. Gail Davidge, research associate2,
  5. Tom Delbanco, professor of medicine1
  1. 1Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
  2. 2Centre for Primary Care and Health Services Research, University of Manchester, UK
  1. Correspondence to: C Blease charlotteblease{at}

What you need to know

  • By 30 November 2022, patients in England who have signed up for an online service such as the NHS App should have prospective access to their primary care health record enabled by default. Access includes GPs’ free-text consultation entries (commonly referred to as open notes)

  • GPs may have concerns about open notes, a practice that has now been implemented in several countries. To date, preliminary findings show that many reported worries disappear with experience.

  • Doctors can empower patients and themselves by implementing a number of techniques and practices in preparation for patient access to their notes.

By 30 November 2022, patients in England who sign up for online services such as the NHS App1 should have access to their full primary care health record prospectively and by default.23 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, and potential risks to patients’ safety.45

With this change, the functionality of the clinical record is also evolving.678 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 …

View Full Text

Log in

Log in through your institution


* For online subscription