“ Patients will rightly expect their personal data to be correct and up-to-date”
valid. Such a prospect suggests that practice managers and GPs may be in for some interesting conversations with parents who suddenly find that they are automatically blocked online from accessing their child’s medical record. Another issue of concern identified by the researchers relates to
the clinician who may be worried about coercion or third-party information leakage within households and may play safe by not recording anything deemed to be sensitive, including early concerns about abuse or maltreatment. Tis may impact on care of the patient – and the use of the medical record as a communication tool between clinicians – causing early warning signs to be missed before concerns are raised.
potential for coercion, when patients may feel pressured to give others access to their online medical record. Older people, teenagers and those with learning difficulties could be most at risk from this: for example, from overt threats or physical force in an abusive relationship, or under the guise of helping a vulnerable relative, especially older people or those with learning disabilities. Tis is an important consideration as traditional subject access
requests are made in writing, which may provide an additional safety net to vulnerable patients as the practice or data controller will at the very least take steps to ensure that the individual claiming to make a request on the patient’s behalf has a legitimate right to do so. Where coercion is suspected, steps can then be taken to investigate the matter further, but this important opportunity is likely to be lost where the medical record can be accessed remotely online on an ongoing or frequent basis, simply by providing a user identifier and password. Parental rights of access also come under the microscope, with
current proposals suggesting that parents will not have automatic access to a child’s record aſter age 12. However, the risk here is that teenagers may still find it difficult to refuse parental requests for access if they are worried it may look like they have something to hide. And what happens when a parent still has access when a competent teenager attends on their own, without their parents’ knowledge, and the practice “forget” parental access is no longer
SUMMER 2015
Going digital So what practical considerations could help manage these significant changes? It is important that practices consider: • Providing patient information leaflets about online access arrangements with an explanation regarding various items in the record. Tis should include a process for patients to follow with a note of whom to speak to if they are concerned/confused about anything they find in their online record. • Reviewing notes before allowing access, specifically relating to third-party and seriously harmful information. As medical records are routinely updated, practices will also require processes in place for ongoing review. • Devising an identity verification and consent process, including the management of proxy access. • The importance of the data quality of records in the knowledge that patients are going to be viewing their data online. Patients have long been able to request access to their records, but ease of online access will increase the numbers of patients who consult their records. • Patients will rightly expect their personal data to be correct and up-to-date. Confusion and concern may be caused by abbreviations, euphemisms, technical language or administrative data. It is important therefore that all staff involved with recording clinical information in the practice are aware and alert that patients will be more likely to read what they record. Time will tell if online access makes life easier for practices in
the long term. NHS England is certainly convinced. National Director for Patients and Information Tim Kelsey has said: “Giving patients access to their full medical records online is a world first – it opens the NHS up to those who use it. “It will be so much easier for people to navigate the NHS. When
online banking started back in 1998, people were distrustful. Now more than 22 million people are using it. “Tese kinds of changes don’t just reduce costs – they also
empower people and allow them to take more control.” n Alan Frame is a risk adviser at MDDUS
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