{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,19]],"date-time":"2026-03-19T20:18:04Z","timestamp":1773951484094,"version":"3.50.1"},"reference-count":71,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T00:00:00Z","timestamp":1751846400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Qual Saf"],"accepted":{"date-parts":[[2025,5,26]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Access to electronic health records (EHRs) has the potential to improve the quality of care. Clinical notes, free-text entries documenting clinicians\u2019 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To 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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methodology<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Nineteen studies involving 203\u2009152 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\u2013provider 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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjqs-2024-018363","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T08:00:17Z","timestamp":1751875217000},"page":"266-274","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Impact of online patient access to clinical notes on quality of care: a systematic review"],"prefix":"10.1136","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-3811-9472","authenticated-orcid":false,"given":"Yoko","family":"Yoshimura","sequence":"first","affiliation":[{"name":"Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9779-2486","authenticated-orcid":false,"given":"Geva","family":"Greenfield","sequence":"additional","affiliation":[{"name":"Global Digital Health Unit, Department for Primary Care and Public Health, Imperial College London, London, UK"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6805-5241","authenticated-orcid":false,"given":"Elena","family":"Lammila-Escalera","sequence":"additional","affiliation":[{"name":"Global Digital Health Unit, Department for Primary Care and Public Health, Imperial College London, London, UK"}]},{"given":"Brian","family":"Mcmillan","sequence":"additional","affiliation":[{"name":"School of Health Sciences, The University of Manchester, Manchester, UK"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2645-6191","authenticated-orcid":false,"given":"Benedict","family":"Hayhoe","sequence":"additional","affiliation":[{"name":"Global Digital Health Unit, Department for Primary Care and Public Health, Imperial College London, London, UK"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2357-9858","authenticated-orcid":false,"given":"Azeem","family":"Majeed","sequence":"additional","affiliation":[{"name":"Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7107-7211","authenticated-orcid":false,"given":"Ana Luisa","family":"Neves","sequence":"additional","affiliation":[{"name":"Global Digital Health Unit, Department for Primary Care and Public Health, Imperial College London, London, UK"}]}],"member":"239","published-online":{"date-parts":[[2025,7,7]]},"reference":[{"key":"2026031902050968000_35.4.266.1","unstructured":"Institute of Medicine (US) Committee on Quality of Health Care in America . 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