Starting Monday all U.S. patients will have free, immediate electronic access to their doctors’ notes and many other types of medical records. Called “Open Notes,” the patient-friendly mandate is part of the federal 21st Century Cures Act that was signed into law in late 2016.

Open Notes was supposed to go into effect Nov. 2 but implementation was delayed due to the COVID-19 pandemic. 

The law requires all health care organizations to create online portals where patients can access the following types of medical records: consultations, progress and procedure notes, discharge summaries, medical histories, physical exam findings, and reports from imaging, pathology and lab tests. Organizations that don’t create these patient-access portals will face fines from the U.S. Department of Health and Human Services.

Doctors are not required to change their writing, but as MedScape reports, some health care organizations are instructing their providers to make their clinical notes more patient-friendly.

Balancing Patient Access with Other Considerations

There are, however, some restrictions on the new expanded access, including eight “Information Blocking Exceptions.”

Psychotherapy Records

Psychotherapy notes that are kept separately from a patient’s main medical records are not covered by the new mandate. The following types of psychotherapy records, however, are included and are accessible to patients:

  • prescription medications and monitoring
  • counseling session start and end times
  • modalities and frequency of treatments
  • clinical test results
  • summaries of diagnosis, functional status, treatment plan, symptoms, prognosis, and progress to date 

State Laws

State laws that can override the federal mandate and block access in particular circumstances, such as a California law requiring providers to talk with patients before uploading cancer test results, according to MedScape. 

Information Blocking Exceptions 

Health care industry professionals are allowed to deny access to medical records when there’s strong evidence that doing so would:

  • Prevent harm to the patient or others
  • Protect an individual’s privacy
  • Protect the security of electronic health information

Other instances covered under the eight exceptions are more technical, such as allowing for information technology system maintenance and the charging of fees when certain conditions are met.