Dr John Lockley, a GP in Bedfordshire and a medical informatician, told a seminar of health IT policy experts and business leaders that uncertainty over patient records in primary care was an ‘elephant in the room’.
The government’s Information Strategy, published in 2012, set a target for GP surgeries to make electronic access to medical records available to all patients by 2015.
A survey by the Medical Protection Society published this week showed that 84% of doctors think making records available online will increase their workload.
Dr Lockley told panelists discussing implementation of the strategy that records should belong to the GP, for the GP’s own information and that handing open access to patients could prevent doctors recording uncertainties.
‘When patients come to see me for the first time I probably know what’s going on in about 50% of cases. It’s my record about the patient, not the patient’s record. It’s my notes about what is going on.
'Because I may be wrong. But it’s my record for reminding me, and sharing with colleagues. If it becomes the patient’s record, that the patient can see at all time, then how can we record uncertainty, such as psychiatric disorders, or the possibility of cancer in somebody who is anxious, or perhaps the possibility of paedophilia: is this girl being abused? How do you put that on a record if the father is going to look at the record immediately he goes home?’
Dr Lockley warned that there was a ‘really big problem’ that patient access could mean doctors either do not record uncertainties, or if they do, could put themselves at risk of legal action or harassment.
Professor John Williams, director of health informatics at the Royal College of Physicians, told Dr Lockley it would be ‘very unfortunate if that elephant was used to stop progress’, and there would need to be a ‘patient friendly and appropriate view’ available for electronic access.
Jeremy Taylor, chief executive of the health charity coalition, National Voices, said the default view that information belongs to ‘the system’ was ‘in principle, wrong’, but that there was a need to educate the public about uncertainty and risk.
Mr Taylor added: ‘My fears about whether I’ve got cancer can’t be any greater that your fears about uncertainties as a GP.’ He argued that patients could cope with openness. ‘I think we’re all maybe just a bit more grown-up than you give us credit for.'
Dr Imran Rafi, medical director at the clinical innovation and research centre at the RCGP, said patients already had access to medical records and GPs were already recording information knowing that patients could potentially access it.
In another discussion at the event, Mr Taylor described social media site, Patients Like Me, where patients compare treatment, as an example of ‘information between patients’ and an inspiring and disruptive innovation.
He said the virtual community was ‘not part of anyone’s strategy and not part of any governance agenda’, and that health professionals had to ask how they could embrace such ‘bottom up’ technologies, which were ‘happening anyway’ and making a nonsense of preoccupations with improving the existing system.