SynthesisBMJ quality & safety2026
Impact of online patient access to clinical notes on quality of care: a systematic review.
Synthesis in BMJ quality & safety, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed.
- Why and how the long case became the OSLER-the sum of the parts.Irish journal of medical science · 2026Article
- Patient Engagement With Open Notes Following the 21st Century Cures Act.JAMA health forum · 2026Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAccess to electronic health records (EHRs) has the potential to improve the quality of care. Clinical notes, free-text entries documenting clinicians' observations and decisions, are central to EHRs. Sharing these notes may reduce information asymmetry, enhance transparency and empower patients. However, their impact on care quality remains unclear.
aimTo assess the impact of sharing clinical notes online with patients on the domains of quality as defined by the Institute of Medicine (ie, patient-centredness, effectiveness, efficiency, safety, timeliness and equity). METHODOLOGY: A systematic review was conducted with no time limit, using CINAHL, Cochrane, OVID Embase, HMIC, Medline/PubMed and PsycINFO. A narrative synthesis method was employed to extract the study characteristics, and reported outcomes were organised using the six IOM quality domains. The risk of bias of included studies was assessed using the Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) tool.
resultsNineteen studies involving 203 152 participants met inclusion criteria. Outcomes included patient-centredness (n=16), patient safety (n=14), equity (n=6), efficiency (n=4), timeliness (n=0) and effectiveness (n=0). Patient-centredness studies reported high satisfaction (n=6), increased engagement (n=11) and stronger patient-provider trust (n=7). Patient safety studies noted improvements in medication adherence (n=4) and note accuracy (n=5), alongside privacy concerns (n=5). Equity studies found benefits for minority (n=3) and less-educated patients (n=2), with one reporting equitable outcomes (n=1). No significant changes in efficiency were observed (n=4). DISCUSSION: Online sharing of clinical notes with patients positively impacted self-reported patient-centredness and patient safety, particularly benefiting underserved populations. However, privacy concerns must be effectively addressed, and robust safeguarding is essential to mitigate confidentiality issues. Further research is needed to evaluate the long-term impact on timeliness, effectiveness and efficiency of care.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.