Research Snapshot: Research highlights benefits and barriers to OpenNotes adoption and implementation
This research snapshot was written by Bay Bahri and is a plain-language summary of the article, “‘I think it’s something that we should lean in to’: The Use of OpenNotes in Canadian psychiatric care contexts by clinicians”, published in 2022 in Digital Health. Available: https://doi.org/10.1177/20552076221144106. Accessed September 22, 2025.
What you need to know
Sharing mental health clinical notes with patients online, known as OpenNotes, can improve communication, patient engagement, and care quality. In this study of 23 Ontario mental health clinicians, participants described potential benefits of OpenNotes such as better patient recall, stronger therapeutic relationships, and reduced stigma. They also identified challenges related to OpenNotes, including unclear policies on when to withhold select clinical notes, limited training on writing patient-friendly notes, and managing disagreements with patients about the content of notes. These findings will help co-design strategies to build awareness of OpenNotes and support OpenNotes adoption in Canadian mental health settings.
What is this research about?
OpenNotes is a movement, which advocates for providing patients with electronic access to their health records and clinicians’ notes. While research in the U.S. and other countries shows many benefits to patients having access to their electronic clinical notes, related to increased trust and empowerment, psychiatric clinicians sometimes worry that sharing clinical notes might cause harm or misunderstandings. In Canada, some hospitals have implemented patient portals, to provide patients with access to their healthcare information, however full access to electronic clinical notes and documentation is more limited and inconsistent, especially in mental health care.
This study explored Ontario psychiatric clinicians’ perceptions of OpenNotes (i.e., providing patients with electronic access to their clinical notes and documentation) to inform the design of implementations strategies to build awareness of OpenNotes and support the adoption of OpenNotes in Canadian psychiatric contexts
What did the researchers do?
Conducted a qualitative descriptive study using virtual semi-structured interviews (45–60 minutes each) with 23 psychiatric clinicians (case managers, nurses, social workers, psychologists, psychiatrists, and residents).
Participants had varying levels of OpenNotes experience (none, <1 year, or ≥1 year).
Interviews were analyzed using directed content analysis, guided by an international Delphi study of OpenNotes in mental health.
Themes were grouped into benefits and challenges of sharing electronic clinical notes with patients.
What did the researchers find?
Benefits:
Patient understanding, recall, and empowerment: Patients can better remember care plans, learn about diagnoses, and engage actively in treatment.
Professional autonomy and efficiencies: Encourages thoughtful documentation while maintaining workflow.
Quality of care and patient safety: Patients can help identify errors, close feedback loops, and reduce stigma.
Relational effects: Builds trust, reduces patient anxiety about what is documented, strengthens therapeutic alliances, and encourages patient-centered language.
Challenges:
Clarity about exemption policies: Need guidance on when it is safe and appropriate to withhold notes (e.g., in cases of intimate partner violence or with certain minors).
Clinician training: Limited support on writing person-centred, clear, compassionate, jargon-free notes that are still clinically useful.
Managing disagreements: Patients may dispute note content, requiring time and skill to resolve.
Patient education: Patients need support in accessing their electronic clinical notes, understanding what is written in the note and learning how to use their notes safely and effectively.
Limitations of the research
Small sample size, mostly early-career clinicians in large urban hospitals, may not represent all psychiatric settings in Canada.
Conducted during the COVID-19 pandemic, which may have influenced experiences with virtual care and note sharing.
How can you use this research?
Policymakers & administrators: Develop clear, safety-focused exemption policies for sensitive notes.
Health organizations: Provide training and peer support to help clinicians write person-centred and understandable notes.
Clinicians: Use OpenNotes to strengthen patient engagement, trust, and transparency.
Educators: Integrate person-centred documentation and communication skills into mental health professional training.
Researchers: Co-design and test strategies that address the identified challenges of implementing OpenNotes in Canadian mental health care.
About the researchers
Kassam, I. 1, Shin, H.D. 1,2, Durocher, K. 1,3, Lo, B. 1,2,4, Shen, N. 1,2, Mehta, R. 1, Sockalingam, S. 1,5, Wiljer, D. 1,2,4,5, Gratzer, D. 1,5, Sequeira, L.1,2, Strudwick, G.1,2
Centre for Addiction and Mental Health, Toronto, Ontario, Canada
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
UHN Digital, University Health Network, Toronto, Ontario, Canada
Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada