London Journal of Primary Care 2011;4:43–8
# 2011 Royal College of General Practitioners
GP Commissioning
Patient record access: making it work for you and the NHS Brian Fisher MBBCh MSc MBE NHS Alliance, Retford, UK
Key messages .
. .
.
Patient record access with added transactional services is available now. It appears safe and is likely to benefit patients and practices across the NHS. It supports QIPP and improves safety and efficiency for practices and patients. It is likely to become routine, but cannot substitute for good traditional communication with and support for patients. Spread is held back by clinician concern for patient and practice safety. However, experience and research shows that risks and side effects are very low, so long as advice is followed. Best advice can be found in the national guidance www.rcgp.org.UK/pdf/Health_Informatics_ Enabling_Patient_Access.pdf
Why this matters to me I have been sharing records with patients for over 25 years, both on paper and electronically. I have always considered this to be a right in both political and ethical terms. Information is power and record access enables a shift in power and control towards the patient,
enabling a change in the dynamic between patient and clinician. The patient can grasp an opportunity to understand more about their own care and begin to shape it – without that basic information, their leverage over the healthcare system is limited. With it, they have part of the infrastructure for a living partnership. Ethically, it seems clear that, within the confines of the law, your medical record should be routinely open to you. In essence, your health your data. Practically, it was easy to offer record access before the electronic record. We just gave people their records in the waiting room. When the electronic record arrived, I set up a company called PAERS Ltd www.paers.net which has now made it possible for all EMIS practices to offer their patients record access to their full GP electronic record. Aware of safety issues, we have designed the system with patient and clinician involvement. We carried out research, much of which is summarised here to establish how patients used access and how it impacts on them and their practices. The reality has surpassed our expectations. People use access in imaginative ways that we had not expected. When clinicians do try it in their practices, they find that it works well and easily, on the whole.
ABSTRACT Background Patient record access is NHS policy. It is now a reality in the UK, although it remains a rarity. Setting This article summarises the current state of patient record access in the UK, focusing on a particular system for which there is most data available. It also explores possibilities for expanded functionality in the near future. This will offer both patients and the NHS a more interactive approach that offers significant benefits to both.
Results Patient record access not only appears safe, but also offers benefits to patients. These include improved safety; a more accurate record; better relationships between patients and clinicians; better data sharing and integration across the NHS; improved self-care and shared decision-making; and better compliance. Practices gain by saving time. In addition, they gain by having empowered patients who can do more for themselves. However, clinicians in general, and GPs in particular, are anxious
44
B Fisher
about enabling record access, fearing loss of control, litigation and breaches of the data protection act. Conclusions Patient record access with added transactional services is likely to benefit patients and practices across the NHS. It supports QIPP. It is likely to become routine, but cannot substitute for
Introduction Policy context It has been government policy for 10 years for patients to have access to their GP records. This has been reemphasised in the Information Revolution, a key part of the coalition government’s reforms to the NHS.1 Most of the government narrative suggests that this has still to happen. However, record access (RA) is available in the UK and other countries now and there is growing experience across the UK of patients having secure access to their full GP record online for free. In fact, most of what the government aspires to is available now. This article distils the UK and international experience of this important development, focuses on experience with one particular system and how GP commissioners can enable spread.
The PAERS/EMIS system enables record access with transactional services in the UK now All practices using an IT system called EMIS, that is 60% of the UK, can offer their patients access to their full GP record online, free to patient and practice.2 The patient can see their full record reformatted so that it is easy to navigate around. In addition, there are
Figure 1 The summary page
good traditional communication with and support for patients.
Keywords: empowerment, patient record access, QIPP, self-care, shared decision-making
automatic links from diagnostic codes to Patient Information Leaflets so that patients can understand better what they read (Figure 1).3 The practice can exclude from view free text and letters either up to a date chosen by the practice or indefinitely. This makes inadvertent breaches of the Data Protection Act very unlikely. The accessible patient data is not held in any place different to current provision. In particular, there is no extra central database. Also, practices have flexibility as to how they recruit patients for access. For instance, they can choose a few patients at the start. Or they can target patients with long-term conditions who benefit the most.
International experience Most experience is in the USA, in Kaiser Permanente and the Veterans Administration, and in Estonia where a fully fledged primary care record access system is in place, linked with certification.4–6 In the USA, RA enables patients to see the whole record (primary and secondary care in the integrated systems), but not usually the consultation record.
Patient record access
45
Box 1 Other ways of having access to your records Paper access to pregnancy and paediatric records They are rarely lost, rarely abused and appear in general to work well with parents and pregnant women sharing with anyone they choose. This is accepted procedure with few apparent problems. Subject access request As part of the Access to Records Act 1990, you apply to your GP or hospital and you will be shown your records, with key aspects of the record redacted in accordance with the Act. RenalPatientView Most renal departments across the UK can offer their patients free access to their renal results and some information about diagnosis and management. Patients find it useful and staff find that it reduces workload. HealthSpace Run by NHS Connecting for Health, HealthSpace intends to offer patients access to their Summary Care Record which will be held in a central database called the Spine where they will have access to their current problem list, their medication and allergies. This will be updated by GP decision at each consultation. HealthSpace is currently under consideration by Treasury.
Clinicians’ concerns and the evidence Experience suggests that clinicians are initially anxious about this level of data becoming available to patients. However, once clinicians have experienced RA as routine, the benefits become apparent and few would revert to hidden data (United Health Group, Seattle, personal communication).
Workload GPs are concerned that patients will demand more and longer appointments for clarification of aspects of the record they do not understand. They worry that will have to write records in a different way. They predict disruption at the reception area. Experience and as yet unpublished research suggests that workload is not increased and probably reduces, particularly if practices make best use of the technology available. For example, in Kaiser, combining RA and secure messaging with patients reduced appointments by 10% and telephone calls to primary care clinicians by 14%.7 Seventy-five percent of patients feel they understand what they read with no alteration of writing style.8
Concern for patients GPs expect that RA will make patients more anxious and confused. The evidence suggests that patients with psychiatric problems are most likely to be upset by what they read, but most say that they are nonetheless keen to continue having access.8 Evidence suggests that 91% of people using RA report that their anxiety was reduced or unaffected by having RA.9
Breaches of security and the Data Protection Act10 GPs are worried that the system will allow patients to see third-party information to which they are not entitled, either because the technology allows it or because the practice’s data handling has breaches. In addition, there is concern that patient data could get hacked. The EMIS/PAERS system has safety mechanisms that enable practices to hide free text in older consultations as well as letters, while allowing patients to continue to have access to their current full record. However, when enabling RA, practices have to ensure that they keep records according to the Data Protection Act.
Loss of income Litigation GPs are concerned that RA will expose errors and that litigation will result. There is no international evidence that litigation increases (Baldry et al 8 and in presentations more recently by the Veterans Administration).
GPs are concerned that RA will deprive them of income generated by insurance and individual patient record access requests. There has been no evidence of this.
46
B Fisher
Guidance is available RCGP has assured guidance on enabling patient access. The aim is to ensure that practical advice is available for clinicians in the occasional tricky situation when decisions need to be made about RA. The guidance can be found at: www.rcgp.org.UK/pdf/ Health_Informatics_Enabling_Patient_Access.pdf
Patients’ experience of RA Based on UK and international data, we now have good evidence about how patients use RA. When asked, the public are keen on RA in principle. A qualitative study in the UK has shown that the main uses fall into three categories.11
Improved participation in care Tracking illness and care over time; feeling more like partners in care, more in control of their management; looking at and tracking test results. ‘The fact that I can also get further information about tests or diagnoses from reputable sources also allows me to be actively involved in my health care.’ (Patient)
Improved quality of care Patients prepare for appointments to save time by checking their records beforehand; they feel that they avoid appointments by gaining adequate information from the record; patients understand clinicians’ communications by checking them online after appointments; patients feel that RA reinforces trust with the practice; it enables patients to improve the accuracy of their record ‘Access to my personal records is an excellent benefit both to myself and other medical specialists – in fact information/test results I have obtained from my records have actually helped other consultants with their diagnosis and subsequent treatment.’ (Patient)
Self-care strategies Patients report that RA assists in understanding what they need to do to self-care better as well as providing the basic data that makes it easier. Patients report that seeing the advice written down in the consultation record is a great incentive to change. This data is supported by other studies that suggest that RA assists in smoking cessation and medication compliance.
‘I have a chronic disease and feel a real partner in the management of my health. Whether I am at home or abroad I can monitor information and share it with any other health professional involved in my care. I would be lost without it now!’ (Patient)
Clinicians’ experience of RA We are now gathering information from practices in the UK who have offered RA through the PAERS/ EMIS system. The majority of practices found it easy to set up and recruitment is slow but steady. The process appears to be time neutral or time saving. Reception work seems to be manageable. Clinicians say that it has helped them in offering shared decision-making with patients. Experience with RenalPatientView and in the USA has shown that once clinicians offer RA, they find that it improves care and their clinical experience (personal data). Very few would revert to the previous data-hidden approach. ‘I have also had patients tell me it is helpful to see what I have written in the notes as it makes clearer my discussion with them and action plans we have made.’ (Doctor)
Risks and benefits Current research suggests that there are few risks to RA. As mentioned above, we know that patients with psychiatric problems are more likely than other patients to get upset on viewing their records. It also seems clear that patients feel that they do not understand about 30% of what they read in the record. About 9% of users feel that RA has made them more anxious. There appear to be substantial benefits as outlined above. These are likely to enhance the QIPP approach and contribute to the efficacy of self-care. However, it is likely that patients may find the advantage of RA on its own to be of limited use. Experience suggests that RA combined with other transactional services will offer the best for patients and practices. For example, as described above, RA plus secure messaging has been shown to reduce primary care attendances and telephone calls. The PAERS/EMIS experience suggests that RA plus appointment booking online and the facility to order repeat prescriptions online has great appeal (Figure 2).
Patient record access
47
Figure 2 The welcome page
Box 2 The future – WEB 2.0 record access It is likely that the PAERS/EMIS system will be able to offer a new set of transactional benefits for patients in the near future. This might include: RA as a portal to a range of NHS services The record becomes not just your window on your own data, but a simple way of accessing a huge range of health information and services, largely tailored to your own needs. Interactive tailored information You will be offered a range of information directly linked to your health needs as expressed by your GP health record. For example, if you are asthmatic, you could have automatic links with Asthma UK, social networking with other asthmatics and up-to-date reports on asthma research. Tailored health advice from your PCT or GP Commissioning Group It will be possible for your PCT to write important localised heath advice to particular populations at risk in their area. For example, send smoking cessation advice to all smokers, with information about local smoking clinics. Flu advice could be automatically sent to all at risk. The Commissioning Group would be able to receive information about how many people had read the data but would receive no information about individual patients. Tailored tools for self-care and shared decision-making It will be possible to link patients to sophisticated decision aids, NICE guidance, and interactive support tools in an automated but personalised way. For example, services such as Microsoft’s Cardio 360 can link, with the patient’s permission, to the record so that the tool becomes a personalised advisor, populated with the patient’s own data. Simpler cheaper and more effective ways to drug trial recruitment It will be possible, with the patient’s permission, to automatically link them with pharmaceutical trials that are relevant to them. They would be offered the opportunity to contact the pharma company directly. This is likely to improve recruitment to trials, currently a significant problem for companies.
How GP commissioners can harness this technology RA is currently only available for EMIS practices. There are three actions that a consortium can take to make most use of RA:
. . .
increase the number of practices offering RA optimise RA use by practices optimise RA use by patients.
Fortunately, there is evidence-based experience about how to do this. Lewisham PCT funded a Record Access Facilitator to visit practices explaining the process and offering practical advice. Practices were offered a small
48
B Fisher
amount of funding for their time. Within six months the number of practices offering RA increased from 2 to 21. We are currently exploring optimising use through a Health Foundation supported project.12
CONFLICTS OF INTEREST
Dr B Fisher is co-director of PAERS Ltd. REFERENCES
Conclusion RA not only appears to be safe, but also offers significant benefits to patients and practices. As the government’s Information Revolution White Paper suggested, RA can become an enabler for a range of important government programmes, such as QUIPP, self-care and shared decision-making. The future of RA may include new ways of patients and citizens interacting with the NHS – supporting independence, behaviour change and a kind of dialogue that has never before been possible. One final point, however. None of these facilities and transactional opportunities are designed to remove the responsibility for the clinician as advocate and guide for the patient. There is a ‘golden triangle’ that needs to be maintained and enhanced – the clinician, the patient and the computer. All three sides need to be in place for optimum gain. ACKNOWLEDGEMENTS
My thanks to Marlene Winfield of NHS Connecting for Health who funded some of the research quoted here and Vanita Bhavnani who carried it out.
1 www.dh.gov.UK/en/Consultations/Liveconsultations/ DH_120080 2 www.emis-online.com 3 www.paers.net 4 https://healthy.kaiserpermanente.org/health/care/consumer/my-health-manager 5 www.myhealth.va.gov 6 www.epractice.eu/en/news/316956 7 Zhou YY, Garrido T, Chin HL, Wiesenthal AM and Liang LL. Patient access to an electronic health record with secure messaging: impact on primary care utilization. American Journal of Managed Care 2007;13:418– 24. 8 Baldry M, Cheal C, Fisher B et al. Giving patients their own records in general practice: experience of patients and staff. BMJ 1986;292;596–8. 9 Bhavnani V, Fisher B, Winfield M and Seed P. How patients use access to their electronic GP record – a quantitative study. Family Practice 2010;1–7 doi:10.1093/ fampra/cmq092 10 www.legislation.gov.UK/UKpga/1998/29/contents 11 Fisher B, Bhavnani V and Winfield M. How patients use access to their full health records: a qualitative study of patients in general practice. Journal of the Royal Society of Medicine 2009;102:539–44. 12 www.health.org.UK/areas-of-work/improvementprogrammes/closing-the-gap-through-changingrelationships/related-projects/patient-record-access
ADDRESS FOR CORRESPONDENCE ETHICAL APPROVAL
Email: brianfi[email protected]
This article is a literature review. It does not require ethical approval. All studies quoted have had appropriate ethical approval.
Read and comment on this article online at www.londonjournalofprimary care.org.uk/
# 2011 Royal College of General Practitioners
GP Commissioning
Patient record access: making it work for you and the NHS Brian Fisher MBBCh MSc MBE NHS Alliance, Retford, UK
Key messages .
. .
.
Patient record access with added transactional services is available now. It appears safe and is likely to benefit patients and practices across the NHS. It supports QIPP and improves safety and efficiency for practices and patients. It is likely to become routine, but cannot substitute for good traditional communication with and support for patients. Spread is held back by clinician concern for patient and practice safety. However, experience and research shows that risks and side effects are very low, so long as advice is followed. Best advice can be found in the national guidance www.rcgp.org.UK/pdf/Health_Informatics_ Enabling_Patient_Access.pdf
Why this matters to me I have been sharing records with patients for over 25 years, both on paper and electronically. I have always considered this to be a right in both political and ethical terms. Information is power and record access enables a shift in power and control towards the patient,
enabling a change in the dynamic between patient and clinician. The patient can grasp an opportunity to understand more about their own care and begin to shape it – without that basic information, their leverage over the healthcare system is limited. With it, they have part of the infrastructure for a living partnership. Ethically, it seems clear that, within the confines of the law, your medical record should be routinely open to you. In essence, your health your data. Practically, it was easy to offer record access before the electronic record. We just gave people their records in the waiting room. When the electronic record arrived, I set up a company called PAERS Ltd www.paers.net which has now made it possible for all EMIS practices to offer their patients record access to their full GP electronic record. Aware of safety issues, we have designed the system with patient and clinician involvement. We carried out research, much of which is summarised here to establish how patients used access and how it impacts on them and their practices. The reality has surpassed our expectations. People use access in imaginative ways that we had not expected. When clinicians do try it in their practices, they find that it works well and easily, on the whole.
ABSTRACT Background Patient record access is NHS policy. It is now a reality in the UK, although it remains a rarity. Setting This article summarises the current state of patient record access in the UK, focusing on a particular system for which there is most data available. It also explores possibilities for expanded functionality in the near future. This will offer both patients and the NHS a more interactive approach that offers significant benefits to both.
Results Patient record access not only appears safe, but also offers benefits to patients. These include improved safety; a more accurate record; better relationships between patients and clinicians; better data sharing and integration across the NHS; improved self-care and shared decision-making; and better compliance. Practices gain by saving time. In addition, they gain by having empowered patients who can do more for themselves. However, clinicians in general, and GPs in particular, are anxious
44
B Fisher
about enabling record access, fearing loss of control, litigation and breaches of the data protection act. Conclusions Patient record access with added transactional services is likely to benefit patients and practices across the NHS. It supports QIPP. It is likely to become routine, but cannot substitute for
Introduction Policy context It has been government policy for 10 years for patients to have access to their GP records. This has been reemphasised in the Information Revolution, a key part of the coalition government’s reforms to the NHS.1 Most of the government narrative suggests that this has still to happen. However, record access (RA) is available in the UK and other countries now and there is growing experience across the UK of patients having secure access to their full GP record online for free. In fact, most of what the government aspires to is available now. This article distils the UK and international experience of this important development, focuses on experience with one particular system and how GP commissioners can enable spread.
The PAERS/EMIS system enables record access with transactional services in the UK now All practices using an IT system called EMIS, that is 60% of the UK, can offer their patients access to their full GP record online, free to patient and practice.2 The patient can see their full record reformatted so that it is easy to navigate around. In addition, there are
Figure 1 The summary page
good traditional communication with and support for patients.
Keywords: empowerment, patient record access, QIPP, self-care, shared decision-making
automatic links from diagnostic codes to Patient Information Leaflets so that patients can understand better what they read (Figure 1).3 The practice can exclude from view free text and letters either up to a date chosen by the practice or indefinitely. This makes inadvertent breaches of the Data Protection Act very unlikely. The accessible patient data is not held in any place different to current provision. In particular, there is no extra central database. Also, practices have flexibility as to how they recruit patients for access. For instance, they can choose a few patients at the start. Or they can target patients with long-term conditions who benefit the most.
International experience Most experience is in the USA, in Kaiser Permanente and the Veterans Administration, and in Estonia where a fully fledged primary care record access system is in place, linked with certification.4–6 In the USA, RA enables patients to see the whole record (primary and secondary care in the integrated systems), but not usually the consultation record.
Patient record access
45
Box 1 Other ways of having access to your records Paper access to pregnancy and paediatric records They are rarely lost, rarely abused and appear in general to work well with parents and pregnant women sharing with anyone they choose. This is accepted procedure with few apparent problems. Subject access request As part of the Access to Records Act 1990, you apply to your GP or hospital and you will be shown your records, with key aspects of the record redacted in accordance with the Act. RenalPatientView Most renal departments across the UK can offer their patients free access to their renal results and some information about diagnosis and management. Patients find it useful and staff find that it reduces workload. HealthSpace Run by NHS Connecting for Health, HealthSpace intends to offer patients access to their Summary Care Record which will be held in a central database called the Spine where they will have access to their current problem list, their medication and allergies. This will be updated by GP decision at each consultation. HealthSpace is currently under consideration by Treasury.
Clinicians’ concerns and the evidence Experience suggests that clinicians are initially anxious about this level of data becoming available to patients. However, once clinicians have experienced RA as routine, the benefits become apparent and few would revert to hidden data (United Health Group, Seattle, personal communication).
Workload GPs are concerned that patients will demand more and longer appointments for clarification of aspects of the record they do not understand. They worry that will have to write records in a different way. They predict disruption at the reception area. Experience and as yet unpublished research suggests that workload is not increased and probably reduces, particularly if practices make best use of the technology available. For example, in Kaiser, combining RA and secure messaging with patients reduced appointments by 10% and telephone calls to primary care clinicians by 14%.7 Seventy-five percent of patients feel they understand what they read with no alteration of writing style.8
Concern for patients GPs expect that RA will make patients more anxious and confused. The evidence suggests that patients with psychiatric problems are most likely to be upset by what they read, but most say that they are nonetheless keen to continue having access.8 Evidence suggests that 91% of people using RA report that their anxiety was reduced or unaffected by having RA.9
Breaches of security and the Data Protection Act10 GPs are worried that the system will allow patients to see third-party information to which they are not entitled, either because the technology allows it or because the practice’s data handling has breaches. In addition, there is concern that patient data could get hacked. The EMIS/PAERS system has safety mechanisms that enable practices to hide free text in older consultations as well as letters, while allowing patients to continue to have access to their current full record. However, when enabling RA, practices have to ensure that they keep records according to the Data Protection Act.
Loss of income Litigation GPs are concerned that RA will expose errors and that litigation will result. There is no international evidence that litigation increases (Baldry et al 8 and in presentations more recently by the Veterans Administration).
GPs are concerned that RA will deprive them of income generated by insurance and individual patient record access requests. There has been no evidence of this.
46
B Fisher
Guidance is available RCGP has assured guidance on enabling patient access. The aim is to ensure that practical advice is available for clinicians in the occasional tricky situation when decisions need to be made about RA. The guidance can be found at: www.rcgp.org.UK/pdf/ Health_Informatics_Enabling_Patient_Access.pdf
Patients’ experience of RA Based on UK and international data, we now have good evidence about how patients use RA. When asked, the public are keen on RA in principle. A qualitative study in the UK has shown that the main uses fall into three categories.11
Improved participation in care Tracking illness and care over time; feeling more like partners in care, more in control of their management; looking at and tracking test results. ‘The fact that I can also get further information about tests or diagnoses from reputable sources also allows me to be actively involved in my health care.’ (Patient)
Improved quality of care Patients prepare for appointments to save time by checking their records beforehand; they feel that they avoid appointments by gaining adequate information from the record; patients understand clinicians’ communications by checking them online after appointments; patients feel that RA reinforces trust with the practice; it enables patients to improve the accuracy of their record ‘Access to my personal records is an excellent benefit both to myself and other medical specialists – in fact information/test results I have obtained from my records have actually helped other consultants with their diagnosis and subsequent treatment.’ (Patient)
Self-care strategies Patients report that RA assists in understanding what they need to do to self-care better as well as providing the basic data that makes it easier. Patients report that seeing the advice written down in the consultation record is a great incentive to change. This data is supported by other studies that suggest that RA assists in smoking cessation and medication compliance.
‘I have a chronic disease and feel a real partner in the management of my health. Whether I am at home or abroad I can monitor information and share it with any other health professional involved in my care. I would be lost without it now!’ (Patient)
Clinicians’ experience of RA We are now gathering information from practices in the UK who have offered RA through the PAERS/ EMIS system. The majority of practices found it easy to set up and recruitment is slow but steady. The process appears to be time neutral or time saving. Reception work seems to be manageable. Clinicians say that it has helped them in offering shared decision-making with patients. Experience with RenalPatientView and in the USA has shown that once clinicians offer RA, they find that it improves care and their clinical experience (personal data). Very few would revert to the previous data-hidden approach. ‘I have also had patients tell me it is helpful to see what I have written in the notes as it makes clearer my discussion with them and action plans we have made.’ (Doctor)
Risks and benefits Current research suggests that there are few risks to RA. As mentioned above, we know that patients with psychiatric problems are more likely than other patients to get upset on viewing their records. It also seems clear that patients feel that they do not understand about 30% of what they read in the record. About 9% of users feel that RA has made them more anxious. There appear to be substantial benefits as outlined above. These are likely to enhance the QIPP approach and contribute to the efficacy of self-care. However, it is likely that patients may find the advantage of RA on its own to be of limited use. Experience suggests that RA combined with other transactional services will offer the best for patients and practices. For example, as described above, RA plus secure messaging has been shown to reduce primary care attendances and telephone calls. The PAERS/EMIS experience suggests that RA plus appointment booking online and the facility to order repeat prescriptions online has great appeal (Figure 2).
Patient record access
47
Figure 2 The welcome page
Box 2 The future – WEB 2.0 record access It is likely that the PAERS/EMIS system will be able to offer a new set of transactional benefits for patients in the near future. This might include: RA as a portal to a range of NHS services The record becomes not just your window on your own data, but a simple way of accessing a huge range of health information and services, largely tailored to your own needs. Interactive tailored information You will be offered a range of information directly linked to your health needs as expressed by your GP health record. For example, if you are asthmatic, you could have automatic links with Asthma UK, social networking with other asthmatics and up-to-date reports on asthma research. Tailored health advice from your PCT or GP Commissioning Group It will be possible for your PCT to write important localised heath advice to particular populations at risk in their area. For example, send smoking cessation advice to all smokers, with information about local smoking clinics. Flu advice could be automatically sent to all at risk. The Commissioning Group would be able to receive information about how many people had read the data but would receive no information about individual patients. Tailored tools for self-care and shared decision-making It will be possible to link patients to sophisticated decision aids, NICE guidance, and interactive support tools in an automated but personalised way. For example, services such as Microsoft’s Cardio 360 can link, with the patient’s permission, to the record so that the tool becomes a personalised advisor, populated with the patient’s own data. Simpler cheaper and more effective ways to drug trial recruitment It will be possible, with the patient’s permission, to automatically link them with pharmaceutical trials that are relevant to them. They would be offered the opportunity to contact the pharma company directly. This is likely to improve recruitment to trials, currently a significant problem for companies.
How GP commissioners can harness this technology RA is currently only available for EMIS practices. There are three actions that a consortium can take to make most use of RA:
. . .
increase the number of practices offering RA optimise RA use by practices optimise RA use by patients.
Fortunately, there is evidence-based experience about how to do this. Lewisham PCT funded a Record Access Facilitator to visit practices explaining the process and offering practical advice. Practices were offered a small
48
B Fisher
amount of funding for their time. Within six months the number of practices offering RA increased from 2 to 21. We are currently exploring optimising use through a Health Foundation supported project.12
CONFLICTS OF INTEREST
Dr B Fisher is co-director of PAERS Ltd. REFERENCES
Conclusion RA not only appears to be safe, but also offers significant benefits to patients and practices. As the government’s Information Revolution White Paper suggested, RA can become an enabler for a range of important government programmes, such as QUIPP, self-care and shared decision-making. The future of RA may include new ways of patients and citizens interacting with the NHS – supporting independence, behaviour change and a kind of dialogue that has never before been possible. One final point, however. None of these facilities and transactional opportunities are designed to remove the responsibility for the clinician as advocate and guide for the patient. There is a ‘golden triangle’ that needs to be maintained and enhanced – the clinician, the patient and the computer. All three sides need to be in place for optimum gain. ACKNOWLEDGEMENTS
My thanks to Marlene Winfield of NHS Connecting for Health who funded some of the research quoted here and Vanita Bhavnani who carried it out.
1 www.dh.gov.UK/en/Consultations/Liveconsultations/ DH_120080 2 www.emis-online.com 3 www.paers.net 4 https://healthy.kaiserpermanente.org/health/care/consumer/my-health-manager 5 www.myhealth.va.gov 6 www.epractice.eu/en/news/316956 7 Zhou YY, Garrido T, Chin HL, Wiesenthal AM and Liang LL. Patient access to an electronic health record with secure messaging: impact on primary care utilization. American Journal of Managed Care 2007;13:418– 24. 8 Baldry M, Cheal C, Fisher B et al. Giving patients their own records in general practice: experience of patients and staff. BMJ 1986;292;596–8. 9 Bhavnani V, Fisher B, Winfield M and Seed P. How patients use access to their electronic GP record – a quantitative study. Family Practice 2010;1–7 doi:10.1093/ fampra/cmq092 10 www.legislation.gov.UK/UKpga/1998/29/contents 11 Fisher B, Bhavnani V and Winfield M. How patients use access to their full health records: a qualitative study of patients in general practice. Journal of the Royal Society of Medicine 2009;102:539–44. 12 www.health.org.UK/areas-of-work/improvementprogrammes/closing-the-gap-through-changingrelationships/related-projects/patient-record-access
ADDRESS FOR CORRESPONDENCE ETHICAL APPROVAL
Email: brianfi[email protected]
This article is a literature review. It does not require ethical approval. All studies quoted have had appropriate ethical approval.
Read and comment on this article online at www.londonjournalofprimary care.org.uk/
