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Get to grips with online records access


TEN WAYS TO


Dr Brian Fisher answers questions on how practices can manage online access to medical records with the minimum of fuss


From April 2016, GPs will be contractually obliged to allow patients online access to coded information from their medical record. This is a step up from the current arrangement where practices only have to, on request, share summary care records online or patients can request a full print-out of their record for a small fee. This move is part of the Government’s much-heralded ‘information revolution’ and follows the inclusion in last year’s GP contract of online appointment booking and repeat prescription ordering. All practice software will automatically offer GPs the ability to tick a box and allow their patients this new access. They don’t have to publicise it, so overall it should mean minimal work for practices. However, GPs need to ensure they are prepared as it will inevitably trigger a growing interest from patients and with some program suppliers also giving practices the opportunity to share free text and letters from April.


What information will patients be able to access?


1


This may vary between computer programme suppliers. But it will most probably include historical


coded diagnoses and data relating to medications, allergies and adverse reactions, test results and details of immunisations. Some programs will offer the option of patients seeing doctors’ comments alongside test results, which could be particularly useful when delivering normal test results. For example, a GP could write the comment ‘High creatinine, but normal for you. Review in six months'. It is worth discussing with colleagues what would be the most appropriate comments to write and how you can ensure patients read them. In the case of a serious diagnosis, GPs will still


82 February 2016 Pulse


need to contact the patient before writing anything in their record. Patients being able to access their


coded information online should in the long run generate a host of benefits. Evidence suggests that it can create better communication and trust between the practice and patient1 and allow patients to make more informed decisions2 as they have a better understanding of their condition. It also means patients can print out their information and share it with other healthcare services. Practices will not be contractually obliged to share retrospective letters or free text online from April, but a lot of the computer programs will offer this from the start, as well as online secure messaging. So GPs do have the option, which they can decide to take up on a patient-by-patient basis. Some program suppliers, including EMIS and TPP systems, allow a practice to select the date from which they can make free text and letters available to the patient online. Evidence suggests that the more patients can see of their record the more time it saves the practice and that it can reduce appointments by 10%.3 Patients will still be able to ask for their full record to be printed out through a subject access request, and practices will have two weeks to exclude items that they think would cause severe damage to the patient. They can charge for this process.


2


Do we have to allow access to everyone that requests it?


Yes, but according to the GMS contract,4 GPs have the option ‘to withhold coded information where


they judge it to be in the patient’s interests or where there is reference to a third party’ – for example, if they think it will cause serious harm to the physical or mental health, or condition, of the


patient or any other person. This could be most likely among people with psychiatric problems. However, ‘serious harm’ is not defined in the legislation, so it is probably wise to err towards offering access. If you need to deny access, you should first discuss it with the patient.


Will it involve a lot of work for practices?


It shouldn’t. Practices aren’t obliged to publicise this facility – NHS England and the software companies are most likely to do this. All software will be automatically updated to offer the new access from April. Patients will need to register online.


3


If you already offer online access to appointment booking and repeat prescriptions, registration should be pretty smooth as the patient may already have login details. If you don’t yet offer online access, you need to be prepared for enquiries from patients and from those wanting to receive their password and pin. I would recommend that partners hold a meeting with staff, particularly with receptionists who are patients’ first point of contact, in the next month to ensure there is a plan in place to deal with this. Many of the computer programs have


warnings for patients about the risks of accessing their coded information that should flash up as they begin to use it, so they are prepared if they read something that worries them or they don’t understand. But it is wise for practices to familiarise themselves with the risks and give written information to patients. Many of the computer programs link Read codes with patient information leaflets that explain what patients are reading, which should help. The RCGP offers a host of information leaflets, posters and template registration forms5 which you can print off and keep on hand to give out to patients.





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