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Gold, incentives and meh

Less than a third of doctors think online access to records is a good idea

Fewer than a third of doctors think that allowing online access to full patient records is a good idea, shows a survey by a medical defence body.

The survey of 850 members of the Medical Protection Society and 1,766 members of the public found 66% of doctors and 73% of the public believed that particularly sensitive information should never be accessible online.

Some 86% of doctors and 80% of the public said they would be concerned for the security of medical records if they become accessible online.

Fewer than 30% of doctors said that allowing patient’s access to their records online was a good idea.

A spokesperson from the MPS said the survey showed that careful consideration should be given as to whether only parts of medical records should be accessible online, with information on particularly sensitive issues such as mental health, sexual health, child protection and counselling automatically redacted from the online record unless patients requested it.

Dr Stephanie Bown, Director of Policy and Communications at MPS, said: ‘MPS has seen firsthand how things can go wrong for patients and doctors when confidential medical information gets into the wrong hands.

‘Patients expect the information they give to their doctor to be kept confidential and if this doesn’t happen, it could cause a breakdown in the relationship of trust.

‘We want a firm commitment from the government that the information strategy will not compromise patient confidentiality – because once the contents of ‘Pandora’s Box’ have been released into the wrong hands, the damage cannot be undone.’

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In a bid to make the NHS more ‘customer friendly’, the former health secretary Andrew Lansley pledged that GPs would have to facilitate patients being able to book appointments, access their records and contact their GP via a secure email system by 2015, as part of the Government’s 10 year Information Strategy.

Dr Paul Cundy, chair of the GPC’s information technology subcommittee and a GP in Wimbledon, south London, said the proposals were ‘self-evidently very sensible’ but need to be carefully managed.

He said: ‘The net effect will lower the threshold by which patients will communicate with health services, that inevitably will result in an increase in workload.

‘If general practice suffers what has happened in the States, where there’s a 25% across the board increase in work, primary care will fall apart as it cannot sustain that level of increase.’

Readers' comments (9)

  • The major banks and credit card companies have been doing secure online access for years. Its only a database just the same. Problem is NHS IT wants to reinvent the wheel.

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  • Did the same survey also look at patients' concern about paper records being left in the back of a GPs car

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  • The costs will be huge for practices. What about visually impaired patients who require their notes to be translated into braille? What about patients who's first language is not English and require their notes to be transalated into their first language? What about the patients who find something written in their notes that they don't understand and then request an appointment with a GP to go through the notes line by line (when we are already struggling with appointments).

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  • What patients need most is access to their laboratory (inc BP), drug, appointments, operations and letters.

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  • What if an abused patient is forced by abuser to show their medical record? What next - insurance companies, prospective employers get access? The medical record is supposed to be a tool for the GP to look after the patient - if full access is granted to the patient, let alone anybody else, this will potentially affect what is recorded. Can we not just be left alone to do the job we trained for and used to love without all this rubbish?

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  • Another problem is the opening up of the record to all and sundry which has led to the GP records becoming littered with rubbish and multiple errors which can only be removed by applying to the person who entered the data. After the mammoth task, several decades ago, of sorting out the paper records to improve safety we now have a system which is potentially extremely dangerous.

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  • Look at the reality, folks. Record access is available now in all EMIS practices and InPS is beginning to offer it too. There is no database as in the C4H model. About 60 practices are offering it in the UK and we have quite a lot of experience from patients and practices. It takes up little time (in fact there is evidence that it would save up to 11% of appts if 30% of patients used online access). There are not loads of extra clinical queries. Relationships improve, evidence for better self-care and shared decision making. Records can be shared with A+E and OPDs - so much safer. There is no simple fix, however, for coercion except for switching off access if it happens.

    As for messaging the practice, we need more evidence and experience before we know whether this is easy to manage and what the benefits and costs are.

    Online access is safe, convenient and probably will save you time if you use it wisely. Go for it!

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  • Technology and the law mean that the survey is irrelevant and GPs plus 90+% of other professionals employed in delivering clinical services will need to move on in their attitudes towards patient access to their clinical information.

    I have all my clinical records online i.e. GP, Hospital, Dental, Ophthalmic etc. plus my daily BP and blood sugar record, my advanced directive and my enduring power of attorney documents are also in my records.

    The financial cost of putting my records online was the square root of zero – which makes me smile bearing in mind the billions poured down the drain over the past few years by the cognoscenti who run the NHS IT section.
    A pdf document explaining how to do this is at this web site

    My online clinical record facility plus my WebEx video conference or Skype facility means my GP or Hospital Consultant / Specialist Nurse / CPN / Physiotherapist or whoever is involved in my care could have a virtual consultation with me for simple conditions or maintenance / follow up issues without the need for me to leave home.

    If need be we could have a virtual grand round with all my notes available plus my carer / social worker should I so agree. I think this would be called an integrated care scenario in certain quarters e.g. the Kings Fund.

    If I am house bound and my GP has had enough home visits for the day – a virtual visit may be just the thing to increase her productivity and value to practice earnings – need to get GP negotiators onto this so that a claim form can be produced to ensure appropriate reimbursement.

    I have effectively broken the power of the state and the professions employed by the state e.g. GPs et al to say what happens to control online access to my clinical records.

    Please see my comments on “Pull the plug' on Summary Care Records, says GPC IT lead” Pulse 14th February .

    Readers may like to see the following Australian approach and the Danish approach to online records which make SCRs look as useful as a like a chocolate fire guard :

    Any reader who would like to have a WebEx meeting with me to go over issues can contact me at

    NHS Constitution page 9: You should recognise that you can make a significant contribution to your own, and your family’s, good health and well-being, and take some personal responsibility for it.

    Having access to clinical information about one’s own health status will help people to take more responsibility for their health.

    GPs above all will understand that the demographics of an ageing society are running against their personal capacity to cope with increasing volumes of service demand.

    Securing a personal responsibility culture shift in the general population requires innovation to citizens the tools to manage their health better for longer if we are to keep up with the expansion of the demand side of the health care system.

    Easy access to online health records combined with guided health care planning / goal setting by GPs and their practice staff has the potential to reduce demand and free up time for patients who need clinical care the most.

    Declaration I am a former NHS CEO with an interest in distance health and predictive health techniques.

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  • We are, quite understandably, seeing the cost-to-surgeries arguments.

    What has been happening for years has been a cost to patients who might want to know even a very small part of their records such as a blood test result. These costs can be seen to include:

    Cost of physical visit to request and/or pick up information.
    Cost of time off work/loss of holiday/etc. to visit surgery.
    Cost of details being made available and/or printed - and I have heard of people being charged ten pounds for a few lines printed on one piece of paper.
    Cost of ignorance - and this is the largest issue. A patient continuing to take or do something because it takes a long time to be told that something else should be done. For example, increase, decrease or stop taking a medicine. Or that information actually never reaches the patient.

    Certainly there are issues to be dealt with but patient experiences have made me decide that I want access. And I want it now.

    Just to be clear, I do not at this time have any outstanding issues. This is a conclusion reached after much thought not as a reaction to an ongoing situation.

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