It is currently a contractual requirement for practices to offer and promote online appointments and repeat prescriptions, and by 31 March next year, practices will also be required to offer patients online access the patient record. The level of access can be decided by each practice but must include coded summary information as a minimum. It is likely that over time increased levels of access will become mandatory. Patients already have access to their full medical record under the Data Protection Act 1998, so allowing online access simply makes it easier for the patient to view their record. And by 2018 patients will be given full access (viewing and commenting on their records.
Although most practices have the IT in place to support patient online access to records, implementation has so far been slow. Patients are poorly informed about online access. A recent YouGov survey of 2,243 adults found that 71% were unaware they could already see their records online if they wanted to. Respondents were enthusiastic about the prospects of online access and thought it would help them manage their health better.
Online appointments and repeat prescriptions have been an overwhelming success – popular with patients, easy to implement, reduced errors and saved a large amount staff time.
Online access to records will have similar benefits. Although you can get away with the minimum requirement – allowing access to just summary information – the real benefits for GPs come when more complete access (to information about allergies, immunisations, investigation results and ultimately full consultation free text) is allowed.
Patients who have access to their record can check when they were last seen, see the outcome of any investigations and view what was recorded along with advice and future management plans. Access to records can reduce unnecessary queries and reminders, for example about monitoring bloods or future appointments. A climate of openness and sharing is helpful, particularly for patients with chronic illnesses.
GPs are bound to be anxious about the implications of opening up access to full records, particularly free text. But we should remember that the patient already has a right to see their records. We already ensure our records are accurate so if a patient contacts us to point out inaccuracies then this is an opportunity to correct an error and not a threat.
We often get contacted by patients who simply want factual information such as dates and diagnoses, immunisations or allergies. Typically this may be needed when filling in an insurance application or other form. With online access the patient can access this information directly. This is convenient for them and a great timesaver.
Widening and promoting online access will be good for patients and good for GPs, and if you have the chance to get started on this project before the new contract, I suggest you do.
Dr Graham Gibson is a GP in York.
Let me make one thing clear at the outset: I am a big fan of patient online access to their own records.
I am also a big fan of antibiotics, but that doesn’t mean I think every patient should have a right to antibiotics on demand.
The problem with the directive that all patients will have access to their full record online from 2018 is that it once again removes from responsible clinicians the right to exercise their appropriate professional judgement, proclaiming a ‘Government knows best’ approach.
My concerns here relate to three situations in particular: vulnerable adults, young adults and safeguarding cases.
For vulnerable adults it is essential they can speak openly to someone to seek help, and often the only person in that position is their GP. The current guidance from the Royal College of General Practitioners has issued draft guidance on the matter of coercion, but, whilst helpful, it does not address all the problems. Implementing it will need a significant cultural change in General Practice, the kind of change that will take a great deal longer than 4 years. In addition there are significant technical changes required: principal clinical systems will need to enable the restriction of individual elements from view online. These restrictions need to be transferred between systems during electronic records transfer s and they must be respected by all information sharing technologies between systems.
For young adults the situation is perhaps more complex still. As children get older they develop an increasing awareness and understanding of their medical history, but this is not a simple all or nothing Gillick-style competence. A young adult may have competence in respect of some aspects of their record, but not others.
How often should this be reviewed and re-assessed? Is the time and effort required to do this safely justified by the benefits for these young people? I have no doubt that in some cases it will be – but by no means all.
Perhaps the most challenging area however is that of safeguarding for children. After many serious case reviews into child deaths We are all aware of the lengths parents will go to in deceiving doctors and social workers – much easier with access to records.
Any patient can request access to their complete record under the Access to Medical Records Act but when a patient makes a request under the Act the notes are checked again for information relating to third parties and any potentially harmful information. Even with this backstop there is a risk, but without it the risks of mandated universal access are too great.
The last two nails in the coffin? The risk that patients may demand the removal of safeguarding concerns from their records, and that doctors may self-censor and not record such concerns lest the patient see them.
This misguided policy runs the risk not only of harming patients, but of doing serious damage to the advance it wishes to promote: patient empowerment through online access to their records.
Dr Geoff Schrecker is a GP in Sheffield and chair of the Watchdog Committee at EMIS National User Group.