Table 2 Open notes’ implementation themes based on capabilities (opportunities and challenges) of PC staff and patients

Ownership and data integrity

Integrity

• Erodes trust in medical records to be complete and reliable

• Possibility of improper use by third parties

• Raises questions about what to be noted in my medical records

Life/ Professional practice

• Limits the ability to practise as a GP because of legal consequences

• Nothing mentioned

Practice organization and care process

Practical reasoning

• PC staff should promote open notes and explain the use of a portal or app

• Enables to respond to patient requests for transparency

• Contributes to keeping the medical records up to date

• Offers the opportunity to check medical records

Healthy life

• Nothing mentioned

• Contributes to living a healthy life

Play

• Does not reduce workload or contribute to job satisfaction for GPs or practice nurses, but it does for practice assistants

• Requires changing in workflow

• Simplifies handling information about your health

Worries and thoughts

Emotion

• Makes me concerned about what the patient is reading

• The information makes me worried or anxious

• Provides insufficient certainty about data security and privacy aspects

Senses, imagination, and thought

• Limits my use of medical language (necessary for transfer) and the writing of the next steps (continuity of care) in the medical records

• Ability to view own medical records

• Ability to read back what has been discussed and reflect on agreements made

Healthcare professional-patient relationship

Affiliation

• Supports an effective relationship with patients

• Influences mutual collegial solidarity in practice

• Supports getting an effective relationship with the PC staff

Control

• Reduces control

• Allows control of the content of the medical records

• Supports autonomy of his/her own health situation