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Medical records - Let patients see their notes online

Dr Brian Fisher outlines how practices and patients can benefit from making records accessible.

Records access improves relationships between GPs and patients. Patients trust the practice more when they see that nothing is hidden (Photograph: SPL)
Records access improves relationships between GPs and patients. Patients trust the practice more when they see that nothing is hidden (Photograph: SPL)

The government has set a target for all NHS patients to have online access to their primary care records by 2015. It is already possible for 60% of UK practices to offer their patients access.

The benefits
Research shows that with records access:

  • Practices' relationship with patients improves.
  • Patients tend to have better outcomes and use health services less.
  • Patients show better self-care and compliance.
  • Patients can improve the accuracy of records.
  • Patients' safety is improved.
  • Continuity of care is improved, because patients can share data with relevant professionals.
  • Patients feel more informed and involved in their care.
  • Patients will call the practice less often because they can see their key data, such as test results, letters and immunisations.

All EMIS practices can now offer patients access to their GP records online, from a web browser anywhere in the world. The service is free. TPP is piloting its version. The GMC, Information Commissioner and defence bodies are all happy with this, describing it as an extension of good practice.

The RCGP has produced national guidance, Enabling Patients to Access Electronic Health Records - Guidance for Health Professionals (available at www.rcgp.org.uk).

What patients see
The practice can choose full or limited access. Full access includes letters, test results, consultation notes, medication, immunisations and allergies.

Information buttons next to Read codes link to relevant patient information leaflets and charitable organisations.

Limited access excludes any free text before a date set by the practice. Patients will still see past coded data, such as Read codes (and information links), letters and test results. This reduces the risk of inadvertent third party data exposure.

Access is not a problem
  • You do not need to write records differently.
  • There is no evidence anywhere in the world of increased litigation.
  • Simple administration arrangements can almost eliminate concerns about third party data.
  • Many practices have never excluded any patient from records access.
  • The practice can choose patients for records access. Some prefer to start slowly; others offer access to particular groups, such as all patients with diabetes.

Before offering access
Consider special patient groups, such as children, and perhaps, people with psychiatric problems; how patients' access to test results can benefit the practice, and ensuring access is Data Protection Act compliant.

Other questions include how receptionists should deal with queries about online access, for example, forgotten passwords, and scanning letters from the patient's perspective for third party/harmful information.

Saving time
US research shows that records access plus secure messaging (available in the UK) results in a 25% reduction in visits and 14% fewer telephone calls, and a US pilot by IT company Cisco found that 87% of its employees with records access spent less time away from work and 72% made fewer visits to doctors.

Preliminary UK research figures suggest that, for every 100 patients who access their records at least twice a year, a practice saves 90 GP appointments, 55 nurse appointments, 18 healthcare assistant appointments and 211 telephone calls.

Care improvements
Sharing their data with clinicians at outpatient departments and A&E has even saved lives.

Patients share records with family members. This can help translation, continuity and better supervision by, for example, an elderly patient's relatives.

Patients with access use consultations more appropriately and only ask questions to which they still need answers. They also understand more clearly the management of their conditions, by seeing what has happened and what is planned.

Records access improves relationships between GPs and patients. Patients trust the practice more when they see that nothing is hidden.

At my practice, patients see test results online after they are filed, with a link to www.patient.co.uk for information about the test, and the GP's comments.

Records access aids self-care. You can ensure patients read your instructions; they can become more confident about managing more themselves. Patients can also inform the practice of inaccuracies.

So give your patients online access to information about themselves and share your experience with others.

  • Dr Fisher is a south London GP, patient and public involvement lead for the NHS Alliance and co-director of Paers Ltd, which enables all EMIS practices to offer record access

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Canvass patients' opinions about accessing their notes electronically.
  • If your patients already have online access to their notes, review the practice's protocol for this, with a view to improving the service. If patients do not have access, hold a team meeting to gather feedback about the idea.
  • Study the RCGP guidance Enabling Patients to Access Electronic Health Records to help you draw up an action plan to introduce or improve access.
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