Andrew Lansley's new Information Strategy paper puts patients at the heart of the healthcare system, and that is to be welcomed. Better communication between patient and their GP, facilitating appointments and repeat prescriptions are all to the good.
But enhanced access to medical records creates its own problems, and difficulties with security remain unaddressed.
Unfettered access to records will present patients with the obvious problem of comprehension: how much will patients understand of their primary and secondary record cards? Records will need annotating by GPs or call for explanatory meetings with patients. Health professionals may be faced with additional and uncosted burdens on their time.
The issue of who owns a patient's medical record remains unresolved, and could become problematic if patients are given the right to alter their records. A patient is clearly the subject of his medical record and he is entitled to view that record. But he does not ‘own' it; the notes constituting the record are a matter of medical opinion and should be acknowledge as such. Before the advent of electronic records the paper version was clearly marked as the property of the Secretary of State, and it has yet to be made plain that nothing has changed.
In this age of phone hacking and widely reported stories of data loss, the security of patient records has been glossed over in Lansley's Strategy paper. There is the potential problem of records covering the transitional period between childhood and adulthood, when parents retain the right of access to medical records which their children may resent. Records can be shared with other professionals, but there is a difficulty here of legitimate access for the wrong reason e.g the receptionist in primary care who looks up her neighbours records. Ironically, the ‘Access to Medical Records Act' has potentially worked against patient interest by allowing insurance firms far greater access to medical records: firms can now take a copy of the entire record, where previously they would have to apply to the GP who could provide an edited version – and thus act as the patient's advocate.
The Information Strategy paper may not have set out to resolve these and other issues of security and ownership, but they remain problems for healthcare professionals and their patients.
Dr Mike Robinson is the medical director of INPS
