From April 2016, GPs will be contractually obliged to allow their patients online access to their own coded information from their medical record. This is a step up from the current arrangement where practices only have to, on request, share the summary care record online or patients can request a full print-out of the record for a small fee.
The move is part of the Government’s much-heralded ’information revolution’ and follows the inclusion in last year’s GP contract of online appointment booking and repeat prescription ordering.
1. What information will the patient be able to access?
This may vary between computer programme suppliers. But it will most probably include historical coded diagnoses and data relating to medications, allergies and adverse reactions, test results and details of immunisations.
Practices will not be contractually obliged to share retrospective letters or free text online from April but a lot of the computer programs will offer this from the start, as well as online secure messaging. So GPs do have the option, which they can decide to take up on a patient-by-patient basis.
2. Do we have to allow access to everyone that requests it?
According to the GMS contract GPs have the option ‘to withhold coded information where they judge it to be in the patient’s interests or where there is reference to a third party’ – for example, if they think it will cause serious harm to the physical or mental health, or condition, of the patient or any other person. This could be most likely among people with psychiatric problems. However, ‘serious harm’ is not defined in the legislation, so it is probably wise to err towards offering access.
3. Will it involve a lot of work for practices?
It shouldn’t. Practices aren’t obliged to publicise this facility – NHS England and the software companies are most likely to do this. All software will be automatically updated to offer the new access from April. However practices are obliged to publicise this facility – although NHS England and the software companies are most likely to do this. The RCGP offers a host of information leaflets, posters and template registration forms which you can print off and keep on hand to give out to patients.
Patients will need to register online. If you don’t yet offer online access, you need to be prepared for enquiries from patients and from those wanting to receive their password and pin.
4. Will I need to rewrite records or change the way I write them in the future?
Coded data will be retrospective, but it is highly unlikely to contain anything that the patient doesn’t know already or third-party data that the patient should not see, considering how brief it is.
However, if you start offering online access to free text and letters, now or in the future, you should be aware that it could contain third-party information. Although patients will only be able to see free text and letters that are filed after April.
5. Do all the computer programs offer the same services to patients?
There will be eight different portals for patients to choose from. Patients will be given outline information about each version when they register for online access and will be able to pick their favourite.
The main differences will be in the add-ons or extra functionality in the basic, free package, for example links from test results explaining what they mean. How it will work with so many different suppliers and how the practices will cope is still unclear, but practices will not be able to recommend a program to their patient. In the long run companies that offer the most attractive service will gain market share.
6. What do I do if a patient challenges a diagnosis?
The new access could lead to patients challenging information in the record, either because a discussion or procedure has been coded incorrectly or a patient does not understand their diagnosis. You may find that this has implications for your practice’s processes so it could be worth discussing it with your colleagues.
7. A patient’s parents want access to their child’s record. Should I give it?
The law is complex in this area and it is likely that every computer system will have a cut-off at 11 years old. Once a child reaches this age, parents will be able to have proxy access to manage certain elements of their record – such as demographic data, making appointments and ordering repeat prescriptions – until their child turns 16.
8. An elderly patient’s son wants access to her record. Do we give it to him?
Proxy access to a family member or carer can be allowed only with the patient’s consent. The practice can only authorise access without this consent if the patient lacks capacity to make the decision themselves and has registered the applicant as a lasting power of attorney.
9. A patient is being coerced by their partner to share their online record. What should I do?
If your patient tells you they are being coerced, you can switch off the patient’s access immediately and suggest they contact the police. Or the practice can contact the police with the patient’s permission. If any member of staff suspects coercion, particularly if the patient is or has been a victim of domestic abuse, the GP may consider not registering the patient and instead offering them an appointment. If they are already registered the practice could consider switching off online access and discussing it with the patient.
10. Is there anything I can do to prevent a patient being coerced?
Many systems will have warnings that appear the first time a patient registers for record access that reminds them of this risk and that they should tell the practice if it happens. Of course, that is easier said than done. And ultimately once the patient can access their coded information, that information belongs to the patient and they can decide what they do with it and who they show it to.
Dr Brian Fisher is a semi-retired GP in Lewisham, south-east London
Declared interests: Dr Fisher is co-director of PAERS Ltd, one of the companies on the GPSoC Framework offering record access across England from April 16. He has carried out some of the peer-reviewed research quoted in this paper. He was involved in the early development of Patient Online
What do you need to do in the next two months to prepare for online record access? Complete the full CPD module (1 hour)