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.

临床医生的笔记服务于越来越多的受众，最近增加的是患者，如果是儿科，则是父母/监护人。OpenNotes 倡议的早期工作，随后是最近颁布的 21 ^stCentury Cures Act 信息封锁规则已强制要求轻松及时地以电子方式访问涉及其临床护理的笔记。虽然已经描述了许多好处并且大多数缺点没有实现，但儿科和青少年患者的护理带来了独特的挑战，以实现这一功能，同时保护患者、父母和家人的机密性。鉴于全州在提供这些保护方面存在差异，在统一协助临床医生做正确的事情同时保持遵守法律方面仍然存在技术差距。需要对在护理环境和学术机构内使用开放式笔记方法的影响和新的工作流程考虑进行更多研究。需要额外的教育和培训来调整笔记书写以适应患者的理解并鼓励患者参与，同时传达医疗决策的复杂性。随着透明度和共享医疗决策在医学领域变得越来越普遍，临床医生的沟通和文档风格需要发展以应对这一挑战。