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. 2023 Aug 23;14(4):654–669. doi: 10.1055/s-0043-1770901

Table 2. 21st Century Cures Act topic thematic analysis results summary table.

Across themes, research has tended to:
 1. Focus on Open Notes more than the immediate release of laboratory test results (i.e., Open Results)
 2. Be conducted at U.S. institutions that launched the changes in advance of the April 2021 deadline
Theme Description Key points
Preparing for Increased patient access Focuses on the preparations that some health care organizations (HCOs) have done prior to providing patients with increased access to their electronic health information (EHI).  • Preimplementation patients are generally positive about increased access, especially to low-sensitivity EHI results such as cholesterol test results. 29 30 Clinicians tend to be more skeptical. 29
 • Literature focuses on clinician-targeted implementation strategies, including education and communication around changing policies. 31 32 33 34
 • Despite some efforts to improve the readability of visit notes for patients, 32 35 limited existing research suggests that the readability of notes postimplementation sometimes remains unchanged. 29 35
Consequences of increased patient access Positive and negative consequences of increased access to EHI, including studies after Open Notes and other Cures Act Compliance efforts have been implemented.  • There are few recently published studies of direct consequences of immediate access to EHI (e.g., incidence of patients viewing test results before clinicians 28 ).
 • Postimplementation, patients remain positive about increased access 36 37 38 39 and clinicians remain concerned. 31
 • Existing literature overwhelmingly suggests that increased access to EHI supports patient engagement without harming the patient–provider relationship, but there is significant risk of bias in this body of literature. 33 35 36 37 38 40 41 42 43
 • There is some evidence that Open Notes may be particularly beneficial to underserved populations, but there is also evidence of disparities in who accesses and uses their notes. 33 35 40 41
Leveraging the Cures Act to engage patients Research considering how to further engage patients by providing additional opportunities for collaboration and technical supports using or building upon the infrastructure being implemented to comply with the Cures Act.  • The few published studies focused on how to improve representation, understandability, and utility of EHI have been promising but have been experimental and limited by low uptake. 44 45 46
 • Patients and caregivers have many suggestions for improving engagement through increased access to EHI such as increasing patient awareness (e.g., advertising availability and utility, notifications, and reminders) and increased clinician training (e.g., using nonjudgmental language in notes). 36 41 45 46