GPs should not be forced to give patients retrospective access to information in their medical records as it would pile work on practices and risk destabilise the doctor-patient relationship, says the RCGP in its road-map for Government plans for online records access by 2015.
The Department of Health-commissioned report says that online access to records should be ‘prospective’ by default and that practices should be able to set an ‘access from’ date for all records.
The college recommends practices assess whether access to information entered prior to this date should be allowed for patients with complex diseases and only on a ‘case-by-case’ basis.
The report, Patient Online: The Road Map, also warns of the ‘unintended consequence’ of an increase in queries from patients when allowing access to patient records online. It also recommends practices should be able to specify which patients were able to see their test results before the GP had reviewed them.
The GPC said the report was a blow to the Department of Health’s plans to give all patients online access to their full patient record by 2015.
According to the report, while 75% of practices have the capability to provide electronic access to medical records, less than 1% of practices- 63 in total- have enabled this.
It concluded that full access to records would be beneficial for patients and would help them remember the advice given in consultations, but the risks would ‘outweigh the potential benefits’.
The report said that access to the full online record would risk disputes with patients and had the potential for legal proceedings against GPs and the patient seeing information from other health professionals they were not meant to see.
The report concluded: ‘It is likely that the workload issues and potential risks outweigh the potential benefits of retrospective access.
‘The default across all items MUST be prospective access only. The ability to set an “access-from” date is essential.’
However, they advocated GPs considering retrospective access to records on a case-by-case basis for patients with complex case histories or long term conditions, who might benefit the most.
The GPC has called for online access to records to be removed from the Government’s proposed DES unless ‘serious concerns’ over workload and data security are addressed. They advise that patients should be able to access a more limited set of data, similar to that in a Summary Care Record, instead.
The RCGP also raised concerns were raised over patients being able to view their test results before the GP reviewed them. It recommended practices should enable this feature for ‘specific patients and specific test results’
The report also said patients editing their own records was ‘potentially harmful if used inappropriately’ and recommended that any comments would need to be clearly identified as patient entries.
RCGP chair Professor Clare Gerada said: ‘Patients gaining access to their own records presents us with great opportunities- and major challenges, not only for GPs, but also for patients themselves and their carers.’
Health secretary Jeremy Hunt said the combined proposals for online access to general practice should save GPs time. He said: ‘For me it’s incredibly important to try and turn 10 minutes into one minute. This whole agenda is about unlocking the efficiencies self-management can bring and trying to harness the efficiencies of IT.’
He added: ‘This is about reducing the workload of GPs. What I want to do is free up GPs’ time because there are some other very big things that we need GPs to do and they are working incredibly hard and are pretty rushed off their feet at the moment.’
GPC negotiator Dr Chaand Nagpaul, said the plans to provide online access to records by 2015 was ‘unrealistic’ and that concerns about workload, information governance and coercion had not been addressed.
He said: ‘This is a report commissioned by the Government and it naturally has to be taken in the context that it is Government funded. Saying that, it does raise issues about the complexities, adverse and unintended consequences from the proposals and does not give the Government a passport to proceed as planned.
Dr Nagpaul added that the DES proposed for practices from April should be restricted to online access to appointments and repeat prescriptions.
He added: ‘It’s fine if individual practices with the capacity or will want to give greater access but we shouldn’t be held hostage to political timescales, and further expansion should be part of a future dialogue once the risks highlighted by the report have been mitigated.’
Pulse Live: 30 April – 1 May, Birmingham
Dr Kartik Modha, a GP in London and founder of Tiko’s GP Group, will look at how technology and social media is changing GPs’ practice at Pulse Live, Pulse’s new two-day annual conference for GPs, practice managers and primary care managers, will cover the latest developments in telehealth.
Pulse Live offers practical advice on key clinical and practice business topics, as well as an opportunity to debate the future of the profession, and a top range of speakers includes NICE chair designate Professor David Haslam, GPC deputy chair Dr Richard Vautrey and the Rt Hon Stephen Dorrell MP, chair of the House of Commons health committee.
To find out more and book your place, please click here.