Resource

Everything health systems need to know about involving patients in open notes.

This resource offers suggestions and materials for communicating with patients and clinicians about open notes. The goal is to help increase awareness and use of open notes.

A man and a woman smiling while looking at a computer screen. The woman is pointing at the screen, and the man is pressing keys on the keyboard. The woman is wearing a jacket with a patch that says 'PEP SQUAD'.
A man and a woman smiling while looking at a computer screen. The woman is pointing at the screen, and the man is pressing keys on the keyboard. The woman is wearing a jacket with a patch that says 'PEP SQUAD'.

Scott MacDonald, MD and Kristin Lutz, photo from UC Davis Health

Now that you are sharing open notes, there are many opportunities to create efficiencies for you and your patients. Take advantage of the opportunities open and transparent communication can offer.

Messaging patients about the benefits of using the portal, including access to open notes, can be an effective way to increase portal registration. We also suggest sending patients home with printed materials and providing in-person support at office visits to help patients register on the portal.

There are many ways to communicate with patients about open notes:

  1. Send an introductory email about your web portal and open notes.

  2. Create an open notes page on your external website and patient portal. You can include links to stories and videos, FAQs, instructions for finding notes in the patient portal, and other helpful resources.

  3. Write an article for your patient newsletter and external website.

  4. Create waiting room posters and materials to give to patients at appointments. You can readily adapt material from this website for such purposes.

  5. Let your patients know about open notes on social media.

  6. Collect and share stories about clinicians and patients who are successfully sharing and reading notes.

Tips to communicate about open notes

Open envelope with letter inside, stylized in shades of purple and pink.

Encourage clinical staff to talk about the notes. Taking a few minutes during an appointment to talk about notes can strengthen relationships between clinicians and  patients. Checking to see whether a note accurately captured a visit promotes mutual understanding and helps gauge the patient’s understanding of the care plan.

Illustration of two speech bubbles, one in white with purple outline and quotes, and the other in pink with purple outline and lines representing text, overlapping each other.

The invitation alone is important. We find that the simple act of inviting patients to read their notes can mean a lot. Research indicates that overall patient satisfaction and trust improve with note sharing. And, with as little as one shared note, patients traditionally considered among those most vulnerable report the biggest positive change in their relationships with clinicians.

Hand-drawn illustration of a smartphone with a gradient purple to pink screen displaying a social media feed with profile icons and texts.

Create an open notes button. Even the most tech-savvy patients find many patient portals difficult to navigate and give up before locating the information they’re looking for. Calling out “open notes” can help patients get where they need to go. If possible, create an “open notes button” that takes the patient from the portal landing page directly to the notes to ensure that they won’t get lost.

Illustration of a medical form with checkboxes, some marked with pink checkmarks, and a red droplet icon at the top, set against a purple gradient background.

Assess satisfaction. To understand how your patients feel about using their notes, consider adding questions about open notes to your patient surveys. Use this as an opportunity to learn how they want to engage with their health information.

A digital illustration of a person wearing glasses and a hoodie, working on a laptop.

Send email reminders. To increase the likelihood that your patients will read their notes, send them reminders. We have learned that sending an email or text to patients when a note is signed and ready to read is highly effective for keeping patients engaged with their medical information. Institutions that send reminders/alerts have a read rate roughly three times that of practices that don’t.

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Get feedback. Work with your Patient Family Advisory Council (PFAC) or patient relations staff to streamline processes for patient feedback, especially when it relates to helping patients locate their notes on the portal or correct inaccuracies in the record.

Black and white portrait of a woman wearing glasses, smiling, with shoulder-length hair, against a colorful pink and purple background.

“When I read the notes, I realized I hadn’t described my daughter’s condition in a way that helped the doctor understand what she needed. I was able to go back and clarify so we could develop a better treatment plan.”

—Amy Fellows, MPH, patient advocate

  • Here is boilerplate language you might consider using when communicating with patients about open notes:

    After a medical visit, doctors, nurses, and other health care providers write notes that summarize important information about you. These notes become a part of your medical record. When a note is shared with you, it becomes an “open note.”

    The most common way to access your notes is through the secure online patient portal that is hosted by your health care provider. Using this secure and free portal, you can, among other things, request appointments, message your health care team, and view your health record, including the notes. If your doctor or nurse does not use a web portal, you can request a digital or paper copy of these records for free. If you are not registered on the portal, contact your provider’s office to find out how to create a portal account.

    Learn more about open notes.

  • Even though open notes have been federally mandated since 2021, some clinicians are still getting used to this level of transparency. 

    Here are some resources to help you understand the impact of open notes and help you make sharing notes a successful experience for your clinicians:

  • Navigating patient portals remains a challenge. We have learned that patients often give up before finding what they need. Health systems that make it easy for patients to access notes, and remind them when a new note is available, find that more patients use open notes to their full advantage.

    Here are some particularly effective examples of how health systems are helping their patients to find notes.

  • Even though access to open notes is a federal mandate, many patients do not realize that clinicians write notes. Patients benefit from messaging about notes and the patient portal. It is best to communicate through multiple avenues, including posters, handouts, email, text messaging, and person-to-person communication by members of the health care team.

Illustration of a healthcare professional in scrubs shaking hands with a patient.

Patient-Family Advisory Councils (PFACs)

Patients are the best advocates for open notes within health systems. Advocates, family, and other care partners often speak up about the need for more transparency in health care.

To make the best of open notes, health systems around the country partner with their hospital or health system Patient-Family Advisory Council (PFAC).

Case Study 1: Patient-Family Advisors at Beth Israel Deaconess Medical Center 

The Patient-Family Advisory Council at Beth Israel Deaconess Medical Center (BIDMC) provides feedback on a variety of health system decisions related to the online patient portal, including reading and use of open notes and test results. In early studies, PFAC members guided the Open Notes Labs research team on projects related to patient experience, safety, and the co-production of notes. BIDMC patients share their open notes experiences in partnership with staff, at conferences, and in articles.

Case Study 2: Patient-Family Advisors at the University of Vermont Medical Center were key to open notes success

In 2016, the University of Vermont Medical Center (UVM) formed an open notes working group. UVM did this well before open notes were required by federal law. The group included three patient and family advisors as well as representatives from departments across the system. The group was charged with making recommendations to the system’s leadership leading up to the start of sharing notes. In June 2017, UVM began offering open notes. For oversight purposes, PFAC members continued to participate in the working group after notes were shared.

A black-and-white portrait of a woman with short dark hair, glasses, and earrings, smiling, with a colorful pink and purple gradient background.

“We would not have been able to move forward as quickly or as unified as we have been without the voice of the patient at the table.”

—Amy Cohen, PhD, UVM Medical Center

  • Create opportunities for them to provide feedback to ensure note-sharing is done well. Develop a plan with your Patient-Family Advisory Council about the steps you’ll take to communicate with key health system decision-makers.

    • Get an open notes discussion on your PFAC agenda to share what you have learned from reviewing the Open Notes Labs website.

    • Invite health system leadership to a meeting to discuss open notes within your organization. Invite your Chief Information Officer, Chief Medical Information Officer, and/or Chief Medical Officer to join you.

    • Find out what the process is for accessing open notes. Is it difficult for patients to navigate to the notes in the patient portal or to request them in other ways?

    • Learn more about how hospital leadership is working to inform and educate staff and patients/families about the availability of open notes.

    • Is there a working group on open notes? If yes, ask to include PFAC members and/or get regular updates from that group and provide regular feedback to them as well. If there isn’t one—start one!

    • Ask PFAC members to provide feedback on how to make the patient portal more user-friendly.

  • PFACs have an important role in educating patients and families about open notes. Advisors can share information through personal networks. You can also work with your health system’s communications staff to develop materials including:

    • A page about open notes for your health system’s website and for the patient portal (link to How Do I Use My Open Notes?)

    • Posters, flyers, and fact sheets for waiting and exam rooms

    • Informational videos for waiting rooms and patient room televisions

    • Newsletter articles

    • Stories for your health system’s social media channel(s)

    Other strategies include:

    • Reaching out to local media to get them interested in your open notes story

    • Setting up advisor information tables in high-traffic areas

    • Providing on-site computers with advisors and staff to assist patients in registering for the patient portal

  • Advisors should give feedback and guide any changes to improve note sharing.

     They can:

    • Help create materials to increase portal registration

    • Advise on the development of a patient feedback survey

    • Provide feedback on survey data and input on how to resolve issues

    • Join ongoing open notes oversight committees

Resources for National Patient-Family Advisory Councils

Patient and Family Advisory Councils: Resources for the Field (American Hospital Association)

Patient and Family Advisory Councils: Providing Patient-Centered Care (Agency for Health Care Research and Quality)

Effective Patient Family Advisory Councils (Institute for Patient and Family-Centered Care)

Stay in touch

Share your PFAC open notes story with us

Open Notes Labs has many useful resources. We can connect your health system with other healthcare organizations that are facing similar challenges and concerns. We are always looking for examples of how PFACs partner with health systems to advance open notes.

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