The Government has set a target: all NHS patients should be able to have online access to their GP records by 2015. The NHS Future Forum has recommended the BMA and RCGP collaborate on implementation.
The GPC supports the principle of patients’ access to their own records, but it outlines risks it wishes to be addressed. I shall respond to these sensible queries with reference to national and international experience, regulations, consultations and research.
In the UK, 60% of UK practices can now offer their patients free, secure online access to their GP records through the EMIS/PAERS system and other suppliers are on their way. These approaches have a different design to Connecting for Health’s system. A number of practices are already paving the way, and research shows they are finding it easy.
In some health systems, such as those of Kaiser Permanente and the Department of Veterans Affairs in the US, access to patient records with a range of online transactional services is opening up a new, highly efficient, collaborative world for healthcare.
Access improves relationships between doctors and their patients, makes records more accurate and saves time. It makes care safer, as people share records with key medical personnel at A&E, out-of-hours workers, at outpatient appointments and with carers, and patients also find it easier to make appointments and order repeat prescriptions online.
Patients are more likely to engage with self-care and shared decision making, feel trusted and more involved in their own care and management and understand more about each consultation – people check their records when they get home. Patients who understand their care and their illnesses achieve better outcomes and make less use of healthcare services.
The GPC notes that patients understand 75% of what they read. But systems like EMIS/PAERS do not merely provide raw data, but something patients can use and understand. Its record system automatically links diagnostic Read codes and test results to relevant accredited information leaflets. Patients can also see practice comments about the interpretation of the results. This is an opportunity to educate and save time. The record becomes a personalised information prescription.
Practices are concerned that access will increase workload, but recent findings suggest access reduces telephone calls and appointments with healthcare workers. It seems to create extra capacity.
Identity verification can be a concern – the right person must see the right record, and only the right record. Identification is currently very good in primary care, and this is a good basis on which to build. The EMIS/PAERS system has many levels of identification and there is evidence that this can put off applicants for access. We do need to get the process secure and simple, and it may be appropriate to offer choice in levels of security. Currently it is not possible for patients to add to their record. Workflow processes would be needed to ensure information was rapidly responded to if required. It is unlikely that patients will ever be able to expunge data.
Of course, coercion is a potential problem. Although the practice is not responsible for what happens to the record after access has been made, nobody wants a child to be coerced by their parents to reveal contraceptive information.
Technically, it will be possible to exclude parts of the record, and right now the practice can switch off access for individuals if necessary. But one of the great benefits of record access – the ability of patients to share data with relevant clinicians – will be lost if the clinician cannot trust that the data is complete.
Patients sharing data directly with companies, such as insurers and solicitors, results in risky exposure for the patient. There is no evidence or experience of this happening here or in the US, but it may need to be made illegal. Patients should be warned to only share through the practice.
There also needs to be cost-benefit analysis. A preliminary study is being carried out in the UK, and early findings suggest that there are considerable savings in telephone calls and appointments, as patients can do many things online instead.
We have record access available now. Let’s use it where we can. It is essential the GPC takes a considered view – but this time let it and the RCGP show the way for the profession. There are huge gains to be made.
Dr Brian Fisher is a GP in Lewisham, south London, patient and public involvement lead at the NHS Alliance and and co-director of PAERS