Dr Brian Fisher: Practices must do more to share records with patients

GP practices need to do more to help patients access their medical records, warns East London GP Dr Brian Fisher.

Some GP practices are still not sharing online medical records with patients in line with their contractual obligations, and others are making the process too complicated. This is something that has to change.

The account below from a patient seeking access to their record sums up what the process can be like at practices that aren't making this as easy as it should be.

'I filled in the form in the practice to get see my medical record. The code arrived in the post, but it only allowed me to order repeat prescriptions or book an appointment. No record access at all.

'The receptionist said I’d need a second appointment with my GP to set that up. The practice manager rang me and said that it was a lot of effort for them since they first had to check whether these could cause me harm if I were to see them. It took her and the GP many of hours of checking and only six people in the whole practice had done this so far.

'She wanted to know why I wanted to have my record. I now have to go into the surgery to have my identity confirmed again and I will apparently be granted access. I was told to expect that this will only be a summary and certainly not contain any letters.' 

What a palaver for this patient! And what a surely unnecessary palaver for the practice.

We are obliged to share coded record access with any patient who asks for it. The practice in the story above is technically correct to consider whether parts of the record could cause 'severe harm'. The Data Protection Act does not define 'severe' so it becomes a matter of judgment.

Experience in other health arenas suggests that the concept is quite tough, going well beyond ideas such as embarrassing the practice or upsetting the patient.

But anxiety on the part of GP practices about sharing records with patients is unnecessary - here are some reasons why:

  • It’s only the coded record.

    That is, problem titles, medication, allergies, immunisations, test results. These are very unlikely to cause problems.

  • Reduce potential queries about test results by enabling doctors’ comments to be seen.

    This means that patients can more easily understand that many minor test abnormalities are of no consequence and are quite safe.

  • You can restrict access before a date that you set.
    So, you only need be concerned about the future, and you can make sure that you record things well and make sure that patients are informed about their conditions and care.

  • If you did want to share more than the coded record, you can restrict that too

    There are good reasons to offer full access, the main one being that you reduce demand on the practice because people can see so many things for themselves that they need to contact the practice less often. There are facilities for excluding from view key sentences in the consultation record if you choose. You can again set a date before which patients would not see letters and consultations.

There is evidence to show that there is mutual gain for practices and patients from allowing patients access to their records. It can improve communication and trust1, improve care by letting patients share their data with clinicians in different environments, potentially even when abroad.

It can save time for practices too because patients no longer have to call to check test results or ask for other basic information. One study suggests that if 30% of patients looked at their records at least twice a year, about 10% of appointments and hundreds of telephone calls could be saved2.

My advice to practices is: embrace online patient-facing services in general and record access in particular. Evidence and experience is reassuring. It offers many benefits and little risk, used intelligently and with simple safeguards. It will increase our capacity to do more with the same resources and the same time commitments. This is the beginning of an exciting revolution in the way healthcare is delivered to - and with - the patient.

  • Dr Brian Fisher is a semi-retired GP and director of Evergreen Life, offering NHS online patient-facing services to England through NHS Digital

Notes

[1] Bhavnani V, Fisher B, Winfield B How patients use access to their electronic GP record—a quantitative study Family Practice 2010; 0:1–7 doi:10.1093/fampra/cmq092

[2] Fitton C, Fitton R, Hannan A. The impact of patient record access on appointments and telephone calls in two English general practices: a population based study London Journal of Primary Care 2014;6:8–15

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