Since 2021, U.S. patients have had the legal right to access their electronic clinical notes — but a new study shows many aren't using it. Fewer than 1 in 5 dermatology patients viewed their visit notes within four weeks, with significant disparities by race, language, and sex. Black, Hispanic, and non-English-speaking patients were notably less likely to engage, raising concerns about equitable access to health information.
Since the 21st Century Cures Act took effect in 2021, U.S. patients have had the right to immediately access their electronic clinical notes — but a new study published in JAMA Dermatology reveals that access doesn't equal engagement. Analyzing over 57,000 outpatient dermatology visits in 2024, researchers found that only 18.9% of patients viewed their clinical notes within four weeks of their appointment.
The disparities were stark. Black and Hispanic patients were significantly less likely to view notes compared to white patients, while non-English-speaking patients were also far less likely to engage. Women, Asian patients, new patients, and those with Medicare were more likely to log in and read their notes. Interestingly, patients from more socioeconomically disadvantaged neighborhoods were more likely to view notes — suggesting heightened information-seeking behavior in underserved communities, though this finding warrants cautious interpretation given the small sample sizes involved.
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Why it matters: Patient portal engagement is increasingly central to care coordination and health literacy. These findings highlight that systemic barriers — language, race, and socioeconomic status — may be limiting who truly benefits from open-notes policies, prompting calls for more targeted outreach and culturally inclusive digital health strategies.
