What is it about?

As of April, 2021 in the USA new federal laws, enacted with bipartisan support, mandate that health providers offer all patients rapid and secure online access to their clinical notes via patient portals (‘open notes’). This practice innovation will also include psychiatry notes. We believe that many psychiatrists and other mental health clinicians in the USA (and beyond) will be unaware about what this change in law means in practice, and its potential impact on patients and clinicians. In this article, we explain what this innovation means for patients and mental health clinicians, and what remains to be understood.

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Why is it important?

Mental health clinicians are understandably concerned that patient access to their notes will lead to adverse effects upon patient care and increase work load burden. Yet the experience and research findings on mental health access to clinical notes has shown clear improvements in patient engagement, therapeutic alliance and medication adherence. Over 7 years of experience in opening up mental health notes indicates far more benefit than harm to most patients.


Opening mental health notes has seemed daunting to every system who has embarked on this journey. Yet over 55 million patients in the USA have participated in OpenNotes prior to the Cures Act going into effect in 4/21, with about 25% of the participating health networks including open mental health notes. It has been remarkably quiet and really a 'non-event' and hopefully should be reassuring to mental health clinicians as this cultural and systemic change unfolds.

Stephen ONeill
Beth Israel Deaconess Medical Center

Read the Original

This page is a summary of: Open Notes Become Law: A Challenge for Mental Health Practice, Psychiatric Services, May 2021, American Psychiatric Association,
DOI: 10.1176/appi.ps.202000782.
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