Medico-legal - Digital innovation in healthcare

MPS medico-legal adviser Dr Pallavi Bradshaw examines the impact of advancing technology.

IT literacy is a problem for GPs struggling under burdensome workloads
IT literacy is a problem for GPs struggling under burdensome workloads

Over the past two decades there have been unprecedented advances in digital innovation, both in day-to-day life and, increasingly, in healthcare. General practice led the way with electronic medical records in the 1990s and digital technology in the delivery of healthcare is rapidly expanding.

It is important to take a measured approach, balancing the benefits against unintentional risk and ensuring that ease and efficiency do not override the interests of the patient.

Electronic records

The use of computers and electronic records in primary care has become normal practice. While the legibility of the record, continuity of care, access to investigation results and ease of disclosure are clear advantages, the quality of the information is only as good as the inputter. IT literacy has posed a problem for many GPs and getting to grips with new technology has been a further challenge.

Even those who are IT literate can fall into the trap of automation when using a computer. Errors can arise with dropdown boxes, and the loss of eye contact when typing in a consultation may seem dismissive, or even rude, to a patient.

One of the original aims of the now cancelled National Programme for IT was a system for sharing medical information across the health service. This principle is still generally accepted by doctors as a good idea. The controversial (and now delayed until autumn 2014) care.data system was designed to collect information from patients' GP medical records in a central database, where it can be analysed.

There are anxieties about the practicalities of safeguarding patients' personal and sensitive information; although names will not be included, the patient's date of birth, postcode, NHS number and gender will be linked to their medical records.

The clinical record is primarily a document to aid healthcare staff in the provision of care, but it will now also be used for secondary purposes. The system has huge potential benefits in being able to provide a complete picture of what is happening across health and social care.

However, the MPS is concerned about the extra burden on GPs to raise awareness, on top of an already busy workload. Despite the safeguards, there is the potential that care.data could undermine confidence in the principle of medical confidentiality for some patients.

Internet and smartphones

The internet allows for searches within consultations for formularies or patient information on diseases and can complement the clinician's medical knowledge.

There are thousands of apps for the medical market, aimed at the clinician or patient, including apps for patients to monitor heart rhythms and BP at home.

While these may enhance patient information and assist the GP, they can also lead to anxiety for the 'worried well' and create tension between the GP and patient over appropriateness of investigations, accuracy of diagnosis and treatment options.

Most practice websites will provide patients with the option to choose and book appointments and request repeat prescriptions, leading to greater control for patients. As with all service industries, GP practices are the subject of customer reviews. These reviews should not be feared as they can help to improve the practice and show that they care about and respond to patient feedback. Practices should take comments seriously and reply to all, without being defensive when responding to negative comments. If the patient is unhappy, they should be invited to the practice to discuss their concerns, or provided with information about the practice's complaints process.

Key learning points
  • Ensure that ease and efficiency do not override the interests of the patient.
  • care.data, the new NHS system which will collect patient information from GP records into a central database, where it can be analysed, has been postponed to autumn 2014.
  • When communicating with patients via email, their identity must be confirmed.
  • GMC guidance must be adhered to when diagnosing and prescribing for patients via teleconsultations.
  • When sharing digital photographs for specialist review, consent must be in place and data must be sent and stored securely.

Telehealth

Face-to-face consultations are still the mainstay of general practice, but teleconsultations are now being used to increase efficiency. Diagnosing and prescribing without examination must be done cautiously, as highlighted in the GMC guidance, Good practice in prescribing and managing medicines and devices.

Patients can also email their GP, but this poses concerns as the patient's identity must be confirmed. Once identity is established, it is important that this correspondence is entered into the medical record.

Text messaging to communicate with patients can be extremely useful, but the practice must ensure it has accurate information and the patient's explicit consent to do this, so as to minimise the risk of inadvertent disclosure to family and friends.

Patients may take digital photographs to send to specialists for review. Care must be taken to ensure there is appropriate consent in place and data are sent and stored securely, retained in the records and not kept on personal smartphones.

The GMC has guidance on this, Making and using visual and audio recordings of patients, which must be adhered to.

Digital technology is increasingly being used in general practice and the opportunities created should be embraced. However, it is important that practices have policies in place to ensure the use of technology is in keeping with professional obligations and that appropriate safeguards are adhered to.

  • Dr Bradshaw is a medico-legal adviser for the MPS

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