New Systematic Review Shows Giving Patients Online Access to Medical Records Notes Boosts Safety and Engagement

Findings strengthen case for digital-first NHS set out in England’s 10-Year Health Plan

Allowing patients to read the free-text notes that clinicians write about them can raise satisfaction, increase medication adherence and build trust, according to the most extensive systematic review led by researchers from our Digital Health theme and Imperial College London and published in BMJ Quality & Safety.

Dr Ana Neves, Digital Health Theme Lead, senior author and an NHS GP, said:

“Our systematic review shows that sharing medical notes with patients can improve safety outcomes, and empower patients to manage their health better.”

Our researchers analysed 19 international studies, including over 203,000 patients, evaluating outcomes across the Institute of Medicine’s six quality domains: patient centredness, safety, equity, effectiveness, timeliness, and efficiency. Risk of bias was assessed using the ROBINS I tool.

Key Findings

• 19 international studies involving 203,152 participants were examined.

• Patient-centred benefits: 11 studies found higher engagement; seven reported stronger patient-provider trust; six showed greater satisfaction.

• Safety gains: patients spotting errors and improving medication adherence were documented in 14 studies.

• Equity signal: non-White, older, less-educated, and non-English-speaking patients often benefited the most.

• No evidence of increased workload or reduced documentation quality for staff.

• Gaps in evidence remain around impacts on clinical effectiveness and timeliness of care.

“These findings give policymakers confidence that opening up records is an intervention that can support the NHS’s digital ambitions.” - Professor Azeem Majeed, NIHR ARC NWL Director and Head of the Department of Primary Care & Public Health at Imperial College London.

Why it matters for the 10-Year Health Plan

The Government’s new Fit for the Future: 10 Year Health Plan for England puts the NHS App and a Single Patient Record at the heart of a ‘doctor-in-your-pocket’ service, promising full record access for every citizen by 2028 (Guardian 2025).

The review’s evidence that note-sharing boosts engagement without raising workload supports the Plan’s goal of shifting demand away from face-to-face appointments.

Demonstrated benefits for underserved groups advance the Plan’s commitment to reduce health inequalities by using digital tools (The King's Fund 2025).

Documented privacy concerns highlight the need for the Plan’s pledged investment in cybersecurity and digital literacy so that every patient can use online records safely and confidently.

Policy recommendations

1. Mandate prospective online access to clinicians’ notes across all NHS settings, building on existing GP record initiatives.

2. Embed plain-language training for staff so notes are understandable and actionable.

3. Co-design digital services with patients and caregivers, with particular focus on older adults, minoritised communities and people with limited digital skills.

4. Monitor impact metrics, including medication safety, service utilisation and patient-reported experience, to plug the remaining evidence gaps on effectiveness and timeliness.

Caveats

While overwhelmingly positive, the review underscores the critical importance of privacy, cybersecurity, and clinician engagement to maintain data integrity and trust.