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Online medical records

All GPs will be expected to provide patients with online access to their medical records by 2015, but not everyone believes it is a good idea. Dr Amir Hannan shares how Haughton Thornley Medical Centre approached online access to records and how their patients responded.

A patient in his mid-50s, Mr P, came to see me. Mr P had just had a routine checkup and had been diagnosed with high blood pressure by the practice nurse. I advised him to have fasting blood tests, provide a sample for urinalysis and have an ECG. I also invited Mr P to consider getting a blood pressure machine so that he could monitor this himself.

After confirming Mr P had access to the internet I agreed to obtain access to his medical records and the hypertension care on the practice website, to help him understand his care so that he would be better informed. I explained to him that he could come back to the practice at any time, as we support his needs, but he does not have to wait for us.

All GPs will be expected to provide patients with online access to their medical records by 2015, but not everyone believes it is a good idea

On a return visit Mr P commented that he felt safer knowing what to expect going forward and when to seek help. This is evidence of a partnership of trust between a patient and a clinician supported by an IT system that is shared with patients.

Mr P is not alone. We started offering online access to records in 2006 – more than seven years ago. Now more than 2,260 patients at our practice have signed up for online access to their records – that’s 19% of the patient population, and the numbers are rising as the word spreads among patients.

Online medical records 10 stage approach

Online medical records Figure-1Hurdles

People often ask: “Were you not worried about harmful or third party data? What about security?” Whilst these are legitimate concerns, so is the need for patients to understand what is happening to them and to be able to follow it, learn from it and share it with whom they like.

Confidentiality

Many patients understand that there may be security risks, but no system is perfect – even paper records can be inappropriately shared. However, a balance needs to be reached on the appropriate levels of security, whilst recognising the needs of the patient and their right to determine what is right for them.

Personally

I have ankylosing spondylitis with associated iritis and now have persistent atrial flutter. I take immuno-suppressants, steroids, anti-coagulants and heart regulating drugs. Wherever I travel I carry three passwords with me on a card – they grant access to all my health information.

I have just had an ablation procedure at a London hospital and as I live in Manchester, had my pre-op consultation by telephone. I could give the nurse all the information she needed by logging on and she had no need to contact the practice except to arrange an MRSA swab.

Advantages

  1. Ordering repeat prescriptions is simple. A few clicks and the practice sends the script to the pharmacy.
  2. Family members in other countries can monitor the health of their relatives and give support (this would be of course, subject to the provision of consent from the patient).
  3. Ability to print out previous correspondence if away from home or in another country.
  4. It’s easy to check blood tests. The patient is aware that their doctor is monitoring the results and will let them know if an abnormal result needs to be dealt with.
  5. The information is always to hand and very accessible.

Going forward

We are in the process of building a strategy in the CCG that supports the needs of patients and the variety of information systems that are needed. We are starting to develop other online services, such as Instant Medical History – this enables patients to contribute to the record and not just access it.

I believe that when published media meets social media it furthers the partnership of trust, meets the challenges of today and tomorrow and enables more people to learn quickly how to support themselves. I hope that in the future many more patients will have the benefits that I enjoy and be empowered to participate more fully in decisions concerning their precious health. Welcome to the Digital Age!

For more information visit: www.htmc.co.uk or email htmcpatient@nhs.net.

Online medical records Figure 2

What has MPS been doing on your behalf?

MPS asked you how you wanted to see medical records used and accessed in the future and the challenges in giving patients online access to their records.

You told us:

  • Doctors and patients need more support. Ninety-two per cent of you said you needed more support facilitating the introduction of online records. Eighty-six per cent of you also said that the public will need more information about keeping records secure and 71% that this should be provided centrally by government.
  • Expectations need to be set carefully. From what you said we think there is disparity between the services that patients expect they will have through online access to their records and what you think is realistic in the immediate term. Care is needed to ensure patients are not promised something by government they will not get.
  • There will need to be changes in culture and mindset. You think there are advantages to be gained from online records and other digital innovations, but that patients will need help to understand the critical role they will play in their own healthcare and how they can use their own information safely and appropriately.

MPS has highlighted your concerns in public debate on this issue, drawing on our international experience. We have shared with politicians, key decision makers and the RCGP working group your view that patient access to online health records has the potential to transform patient care, but that in order to realise the advantages great care needs to be taken to manage the associated risks.

It is not enough to just equip patients with the ability to access their medical records online and inform them of their rights; patients also need to be supported and informed about how to understand and use their information safely, appropriately and effectively. We think more consideration needs to be given to getting these support needs right.

For more information read our full report Online medical records and the doctor-patient partnership on our website.

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