Going 'paperless' will take time and money - and brings real risks
My practice has offered online services for a couple of years now, writes Dr Claire Forde, but it has been a time-consuming, expensive and complex process that poses substantial risks to all parties.
By 2015, general practices will be required to facilitate patient access to their records via secure email system: this poses several practical and worrying challenges for general practices.
With equality and diversity high on the NHS agenda, the implication is that GPs will need to provide all patients with access to their personal records in a meaningful way. For example, we will need to consider how to cater for our visually impaired patients who may require their notes to be converted to Braille. We all have patients in our practices whose first language is not English. We need to consider the processes to be put in place to convert patient’s notes into their first language. This is more difficult when you take into account the many abbreviations used in patient notes.
With the introduction of secondary care letters being copied to patients for their information, I have seen an increase in the number of patients coming into surgery anxious, upset or unclear about the information supplied in the letter. This then leads to a significant amount of time being spent going through these letters with patients explaining the medical terminology and abbreviations used. When I write a letter to one of my patients about their medical condition, it is a very different letter to one I may send to a secondary care colleague. In my letters to patients, I would take great care not use medical abbreviations and would avoid the use of medical terminology. Entries that I have made in patient notes over the years have been written with only my medically qualified colleagues in mind with extensive use of medical terminology which I expect will make very little sense to a patient.
Some patients better off in the dark
Equally, I believe there may be occasions when it may be detrimental to a patient’s wellbeing to view their own notes. It may be appropriate to ensure that all patients sign a declaration to ensure that they accept any emotional or psychological consequences to seeing their notes.
As GPs, we often care for whole families within our community. Being aware of other family member issues can be really important when treating patients within our practices. It is not unusual for a GP to document details about a patient’s extended family when it is clinically appropriate to do so. Consequently, prior to allowing patients access to their notes, they would need to be individually reviewed to ensure that sensitive information is not being distributed to patients.
This task alone would take years to complete and would be like searching for a needle in a hay stack. One missed entry could cause significant patient distress and lead to litigation.
There is also the issue of how to temporarily ‘block’ this information while a patient views their notes as it would not be appropriate to delete the entry permanently.
All of these issues could prove costly and time-consuming, in addition to the cost and time taken to set-up the service initially. Many practices will not be in a position to fund these added tasks and will look to their CCGs for financial assistance, but at the same time, CCGs risk vicarious liability issues if member practices do not fully comply with this government initiative.
My practice has had online access for appointment booking, prescription requests, messaging the practice with queries and complaints for over two years and it has proved popular with staff and patients. However, giving patients access to their notes is not simple, and has the potential to carry a significant financial burden to practices and CCGs.
Dr Claire Forde is a GP in Runcorn, Cheshire. Dr Forde is also .the prescribing lead for Halton CCG but this article does not reflect the view of the CCG.
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