Notes at your fingertips: Open note considerations regarding pediatric and adolescent care

The clinician's note serves an increasing number of audiences, the most recent addition being the patient and, in the case of pediatrics, the parent/guardian. The early work of the OpenNotes initiative followed by the recently enacted 21^st Century Cures Act Information Blocking Rule has mandated easy and timely electronic access to notes involving their clinical care. While many benefits have already been described and most drawbacks unrealized, the care of pediatric and adolescent patients brings unique challenges to enable this functionality while preserving patient, parent, and family confidentiality. Given statewide variability in affording these protections, there remains a technological gap in uniformly assisting clinicians to do the right thing while remaining compliant with the law. More research is needed on the impact and new workflow considerations for using an open notes approach across care settings and within academic institutions. Additional education and training are needed to adapt note writing to accommodate patient understanding and encourage patient engagement while conveying the complexity of medical decision making. As transparency and shared medical decision-making become more prevalent within medicine, clinicians' communication and documentation styles need to evolve to meet that challenge.