I believe that all patients should have ready access to their medical records with only a few exceptions. One major exception is obvious: patients should not learn about a serious disease for the first time during their medical record review. Such total access is a logical step in empowering patients to take more ownership for their own health. When patients are able to review physicians' notes, I believe that the notes will become shorter and more accurate. It will also suppress the use of repetitive "templated" entries in hospital EHRs (see: Distrust of "Templated" Physician Notes in EHRs; Implications for the Future; Three Ways to Document a Physician/Patient Visit in an EMR). A recent article by Walker, Darer, Elmore, and Delbanco in the NEJM discussed the path to "transparent medical records" (see: The Road toward Fully Transparent Medical Records). Here's a short excerpt from it; link to and read the whole article if you are interested.
....[I]n 1996 the Health Insurance Portability and Accountability Act entitled virtually all patients to obtain their records on request. Today, we're on the verge of eliminating such requests by simply providing patients online access. Thanks in part to federal financial incentives, electronic medical records are becoming the rule, accompanied increasingly by password-protected portals that offer patients laboratory, radiology, and pathology results and secure communication with their clinicians by e-mail. One central component of the records, the notes composed by clinicians, has remained largely hidden from patients. But now OpenNotes...is exploring the effects of providing access to these notes. Beginning in 2010, at Beth Israel Deaconess Medical Center..., Geisinger Health System ..., and Harborview Medical Center..., more than 100 primary care doctors volunteered to invite 20,000 of their patients to read their notes securely online. Although only a small minority of these doctors' patients used the portals, the initial findings were striking. At the end of a year, four of five patients had read the notes, and among those who responded to a survey, large majorities reported having better recall and understanding of their care plans and feeling more in control of their health care. Moreover, two thirds of patients who were taking medications reported improved adherence. Doctors reported little effect on their work lives and were surprised by how few patients appeared troubled by what they read. Although the notes were not formally evaluated, the majority of doctors reported not modifying their tone or content. A minority, however, reported changing the way they addressed four potentially charged topics: cancer, mental health, substance abuse, and obesity. After the first year, 99% of the patients surveyed wanted “open notes” to continue, 85% of the patients indicated that ready access would be important for their future choice of a provider or system, and no doctors chose to discontinue the practice. Despite limitations in the sample, the findings persuaded our three institutions to implement open notes broadly.
In its web site, OpenNotes is described as a new standard of care. I don't believe that this is an exaggeration. Given that HIPAA in 1996 granted patients full access to their medical records, any further discussion of whether this is a good policy is largely moot. Here is a quote from my blog note of more than three years ago on this topic (see: Should Patients Be "Allowed" to Read Their Medical Records?):
[L]et me dismiss the idea that there is much room for debate about whether patients should be allowed to review their own medical records. HIPAA gave them the right to read, and even amend, these records years ago. Whether this is a good idea is being addressed in an ongoing study (see: Should Patients Read the Doctor’s Notes?). Regardless of whether it's a good idea, I don't think that the law will be reversed on the basis of one or more current studies.
So now we have the results of a major OpenNotes study: patients very much liked access to physician notes and the felt more in control of their care, not an unexpected outcome. As a result of their engagement, they were more compliant with prescribed drugs. The question before us now is not whether we make our electronic records available but how we make them more accessible. The obvious answer for hospitals is to give patients electronic tablets, if they do no come with their own, and then provide a unique ID and password for access to their personal records while hospitalized (see: Docs Prescribe Tablets For Better EHR Access).