eNewsletter - June 2021

21st Century Cures Act: How it concerns mental health clinicians and the patients we see
By Dylan Panuska, PsyD, CADC

Through the 21st Century Cures Act, a landmark healthcare information law, patients now have the legal right to have immediate access to behavioral health progress notes in their electronic health record.

The Cures Act, which took full effect April 5, aims to increase transparency and empower patients to take a more active role in their healthcare. But it has also raised many questions, particularly as it relates to how mental health organizations and clinicians share these notes with patients and their families.

Similar to other organizations across the nation, Linden Oaks continues to navigate some of the challenges of the Cures Act, yet we are also realizing the benefits of sharing progress notes with our patients. In my own one-on-one counseling sessions, patients have shared how reading their notes prompted reflection or was a useful reminder of action plans.

OpenNotes, an international organization that has studied the impact of transparency in communication between clinicians and patients, reports patients who read their notes recall their care plan more accurately, are better prepared for visits, take better care of themselves, take medications as prescribed more regularly and have better relationships with their healthcare providers. They also discovered sharing notes helps improve patient safety and, in some cases, patients have helped identify critical errors in their records.

Although transparency is the goal, there are times when blocking or hiding notes is prudent. The Cures Act allows clinicians to still block notes if doing so aids in preventing harm to the patient or others. Such blocking, however, is the exception and should only be done on a case-by-case basis.

Patients may also opt to have their own notes blocked. An adolescent, for example, may request notes be blocked from a parent/guardian who has access to their electronic health record. In some instances, a patient may decide that they don’t want to see their own notes and request to have them blocked.

In any event, any blocked notes can be unblocked at a future date. Therefore, as clinicians we must be aware of the effect reading our progress notes may have on our patients and if others with access to the patient’s record, such as an adolescent’s parent/guardian or an adult’s spouse, should have access to those notes.

In past practice, progress notes were largely used to document a patient’s diagnosis and the need for ongoing care. While it is still necessary to document those aspects, it is important to keep in mind that, with few exceptions, our patients will read our notes. You may find it helpful at the end of each session to recap and let your patients know what your notes will include.

As you write your notes, consider:

  • Referring to your patient by their first name.
  • Your patient is more than a diagnosis. Putting a patient first in the language we choose can be beneficial in their care. Instead of writing that a patient seeking treatment is depressed, consider writing something like “Mary is a young professional who manages her depression with medication and therapy.”
  • Celebrating progress. Insurance or other healthcare providers are not the only ones reading your notes. Including the positives encourages your patients and reminds them of the progress they’ve made. It also gives other healthcare providers a more complete look at your patient’s health.

As clinicians, we often talk to our patients about “leaning in” to changes that may seem uncomfortable at first. The Cures Acts provides the opportunity to not only model the “leaning in” that we ourselves talk about, but also helps open communication between clinician and patient and provides a pathway for better health.

Websites for more information: