Q: The doctors who did sign on – did they do so grudgingly, or enthusiastically?

A: There was a broad range. Some were enthusiastic. Some kind of said, "Well, it's going to come anyway, I might as well try it." And some were, frankly, almost conscripted. So there was a range of expectations. About 80 percent of the doctors who told us to go to hell felt it would mean more work for them. About 50 percent of the doctors who volunteered also felt it would mean more work.

We did a study before we started – we studied the expectations of doctors and patients – and then the study that got us all the attention was, after we had done it for a year – what happened.

We asked three basic questions: First, will patients read their notes, and will they report benefits from them? Number two, will it (overburden) the doctor? And number three, after a year, will the patient and doctor want to continue? They were very simple research questions.

The results were that the patients were extraordinarily enthusiastic: 80 percent of them read their notes. That said, one out of five chose not to read their notes. I always make that point: freedom of choice. We had a wonderful quote from a woman in Maine who said, "I want to have it, it's all mine, it's my business. But I may not read it."

So, 80 percent read them, but 99 percent said the practice should continue. The patients loved it. And more importantly they reported really important clinical benefits: 70 percent felt more in control of their care and better educated. They felt better prepared for visits. They remembered their visits better, which is a big issue – you go to your doctor and you remember about 40 percent of what happened, and what you remember may be wrong. It's a high-stress situation, even if you're well.

It's a big deal. And the biggest deal of all is that about 70 percent of patients said they were taking medicines better. Which, even if it's a five-fold exaggeration would be mind-blowing.

They also shared them with other people: 35 to 40 percent of patients shared their notes with other people. That's important. You share them with your aunt the doctor or your cousin the lawyer. You can put them on Facebook, if you want. The doctor-patient relationship is confidential. But whether it's private now is up to you. You can download now and share with whomever you want and say, "What do you think?" You're in control. It's much more your record than it ever was.

Q: And the doctors? What were their early thoughts?

A: Not one doctor quit. They didn't all love it. They wrote their notes somewhat differently – about a quarter of them did – but not one quit after a year. And we now have thousands and thousands of doctors doing it and we've not heard yet about one who's started, then stopped.

Partly, because I think patients just expect and want it. Eighty-five percent of patients said it would help determine their future choice of provider – whether or not OpenNotes was present. Once they tasted it, they really wanted it.

Two years after we published these results, we had this amazing spread – and to flagship places. It's kind of a who's-who of American medicine: Mayo and Cleveland Clinic and Kaiser Northwest and Dartmouth-Hitchcock and University of Colorado. etc. It's a lot of very fancy places.

The next trick is to spread it to what's called the early majority. The people in the real world who serve real America. Mayo Clinic is not the real world. So that's our next goal, to go from 5 million to 50 million. And our real goal is to have it become the standard of care in this country.