Dr Geoff Schrecker shares his views on why GPs should encourage patients to view their medical records online and how to go about gaining adoption, understanding and consent from patients.
With the growing opportunities afforded by technology, doctors, nurses and clinicians of all types can now share clinical records with each other, but when you ask your patients for their consent for this sharing do they really know what they are consenting to? Do they know what is in the records? After all, consent is meaningless if it is not informed.
For me, the best solution for this dilemma is to offer the patient the opportunity to view their own medical records online. All GP clinical systems now offer the ability to give patients an online view of their medical record. This access may be limited to certain aspects, or more extensive, depending on the needs and wishes of the patient, but by giving them access to their full coded record you know that they will be making an informed decision.
Of course, this is not the only reason you might want to give the patient access to view their record. So what are the considerations when setting up online access, and how to go about it?
Understand how to implement online services for your clinical system
The first step is to make sure that you understand the implementation of your own clinical system and practice. The different GP systems have different levels of access and control, and you must understand how this works. Based on these factors each practice will then have its own procedures for ensuring the age implementation of patient online. If you or your practice are unsure about this it is well worth visiting the excellent RCGP Patient Online Toolkit For Evergreen Life, there are configuration guides available for EMIS, TPP and Vision.
Put yourself in the patient’s place – set up a test patient
Next set up a test patient so that you can see what the patient will see, this will be helpful when discussing use of the system with your patients. Remember, different patient portals will look different, so it’s worth you trying a few yourself too so that you can compare the views, then you can advise your patients accordingly. It is also wise at this point to make sure you know how your system handles the withholding of sensitive data and editing of third-party information. You can experiment with these settings and see how it appears in the patient portal.
Which patients should you approach first?
Start with some patients you know well, and with a clear reason, for example, a patient having regular blood monitoring who may find it easier to log in and view their results with your comments rather than ringing the surgery. I found this a great place to start as it really does benefit everyone from the outset.
Once you have set this up for a few patients you can consider other situations where it may be particularly useful: the patient attending lots of clinics who never have her notes, the patient with multiple morbidities who travels all over the country. With each patient, you see ask yourself: if this patient has access to their records might it make my practice workload a little lighter? You’ll be surprised how often the answer is yes if you keep an open mind!
Patient engagement is key
We all know that patients have very different levels of engagement in their care, but it is worth discussing online access even with those patients whom you think will not be interested. Of course you will be right most of the time, but be prepared for some pleasant surprises. Online access can be just the trigger that some people need to develop their engagement with their care.
Of course, there is no “pill for every ill” and there are some patients for whom online access may not be appropriate. It is particularly important to be aware of patients who may be vulnerable to coercion, and the RCGP toolkit has a useful section on dealing with issues related to this. You may also want to watch a session given by Professor Gene Feder
Ease the load with online record access
Patient records access is not the silver bullet that will solve all the problems in your practice, but once you start thinking about it for every patient you will find lots of opportunities for the small gains that will help you get home just a little earlier each day. Oh, and when that patient says “yes, do share my records” their consent may be valid!