Complex sentence: Critics cite several challenges in the implementation of opennotes into medical care practice, including how opennotes can further complicate difficult patient cases with possible mistreatment, substance abuse, and dementia.
Split into simpler sentences: Critics cite several challenges in the implementation of opennotes into medical care practice. Concerns include how the practice of open notes could further complicate difficult cases involving patients experiencing possible mistreatment, substance abuse, and dementia.