Patient Information in a Changing Legal Landscape: Cures Act, Open Notes and Electronic Medical Records

In 2021, federal rules from the 21st Century Cures Act mandated that most clinical notes be made available in real-time, online and free of charge to patients. This practice, commonly known as "open notes," was a significant step towards enhancing medical information transparency–– a vital step in reinforcing trust in the provider-patient relationship. However, it also introduced complexities, raising questions as to what to include in the notes. "The ethical analysis does not always align with the legal analysis, and these are conversations that ethicists are aware of," Steven Bondi, MD, JD, says.

Dr. Bondi, a lawyer turned doctor, is renowned for his expertise on the Cures Act, Open Notes and Electronic Medical Records. He specializes in pediatric medicine at Golisano Children's Hospital and is an associate professor within the Department of Pediatrics at the University of Rochester Medical Center. "I think that knowledge is important, and we need to know what the law says and what its parameters are and when we can use the exceptions," Dr. Bondi says.

Dr. Bondi recommends multiple resources on this topic. He suggests visiting healthit.gov and navigating to their information blocking section for informative FAQs and webinars. He also recommends the Guttmacher Institute as a source for general knowledge around adolescent health and privacy. Lastly, he explains that he was recently a part of the American Academy of Pediatrics' committee on medical liability and risk management where he helped produce a monthly column called 'Pediatricians in Law.'

This episode was recorded at the 2023 American Academy of Pediatrics National Conference and Exhibition. Some highlights from this episode include: 

• How to navigate difficult situations and avoid labels 
• The role that ethics play in this discussion
• Confidentiality in adolescents by state
• Biggest pitfalls and gray areas