Sharing EHRs - A GP and patient perspective

Health Informatics New Zealand www.hinz.org.nz Sharing health records A general practice and patient perspective Sandra Hicks, IPAC, December 2006 • Local general practice and patient perspective • Pointers from the UK • What should we do in New Zealand? 1

Health Informatics New Zealand www.hinz.org.nz Sharing Electronic Health Records • What • When • Why • Who But not • How or • Where General Practice • A typical general practice? 2

Health Informatics New Zealand www.hinz.org.nz Halswellhealth Halswellhealth – the partners 3

Health Informatics New Zealand www.hinz.org.nz The surgery 4

Health Informatics New Zealand www.hinz.org.nz The records Demographics The patients • 9261 enrolled patients • 4305 male • 4955 female • 6% Maori • 1.5% Pacific Island • 2.6% Asian 5

Health Informatics New Zealand www.hinz.org.nz Demographics The Staff • 4 partners, soon to be 5 • 3 associate doctors • 1 GP registrar • 5 practice nurses (& often a student nurse) • 5 receptionists • 2 administrators • 1 practice manager • 1 podiatrist The practice manager is the only full-timer, although all the partners work at least 40 hours per week in the practice Shared Electronic Health Records • Why? – Rapid access to clinical information • e.g. allergies, medication lists, past surgery – Prevent duplication of labs, Xrays etc • Test and Xray results available electronically – Reduced administration time chasing missing notes, results, referral letters etc. 6

Health Informatics New Zealand www.hinz.org.nz Shared Electronic Health Records • Why not? – Privacy – Security – Takes more time – particularly in general practice • Generating health summaries • Recording (in a standardised way) the reasons for prescriptions 7

Health Informatics New Zealand www.hinz.org.nz Shared Electronic Health Records • What do the patients think? 8

Health Informatics New Zealand www.hinz.org.nz Patient Questionnaire Sharing Your Health Records • At the moment your health record is held in many different places, although mostly with your GP (general practitioner). But obviously some information relating to you can also be held at the hospital, with GPs in other cities, physios, the laboratory (blood tests), and at the local after hours surgery or other places that you may have visited. • This could cause problems as each place may not have a complete record of your health experiences when looking after you. Things such as your medications, allergies, any previous operations and recent blood test or X-ray results may not be available to the person that you are seeing. Patient Questionnaire cont • Health Information New Zealand (HINZ), a government initiative, along with the Ministry of Health, ACC and other organisations are looking at developing an electronic health record where at least some parts of your record would be available to other health professionals. • I have been asked to speak at a HINZ seminar about what GPs think about sharing health records electronically. I am particularly keen to ensure that I advocate accurately on your (i.e. patients’) behalf when giving this presentation. 9

Health Informatics New Zealand www.hinz.org.nz Patient Questionnaire cont • To help me I would like to know what you think about sharing your health records with other health professionals. I have designed some questions and would like your help. Please be really honest in your response to these questions. • On a scale of 1 to 5 please indicate how happy you would be to have the following pieces of your health record available centrally to all health professionals who can access a secure electronic health network. Very happy Do not want this ever 1 2 3 4 5 Patient Survey – 100 surveys, return rate of 90% Age and Sex of respondents 40 number of respondent 35 30 25 female 20 male 15 not stated 10 5 0 <25 25-40 40-60 60+ age 10

Health Informatics New Zealand www.hinz.org.nz years at the practice 50 average number of 40 years =17.25 (7 people did not respond to this 30 question) years 20 10 0 1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65 69 73 77 81 85 89 respondents What would you be happy to share? • The list of medicines that you are taking • A list of medicines that you are allergic to • A list of current and previous health problems (e.g. asthma, diabetes, hysterectomy, knee reconstruction etc) • The records from hospital admissions • Summaries of hospital admissions (like the discharge letter that goes to your GP) • The records from your general practitioner • Summaries of problems for which you have seen your general practitioner. 11

Health Informatics New Zealand www.hinz.org.nz What would you be happy to share? • What about lab results – at the moment these are held by the person who requested them, and at each of the three laboratories (Southern Community, Medlab and Canterbury Health Laboratories). • How comfortable would you be to have all the laboratory results go into a central laboratory repository which could be looked up by other health professionals who were treating you? Sharing health record patient degree of com fort (scale 1 to 2.5 2 1.5 1 0.5 0 h o s p ita l M e d ica tio n s s u m m a rie s s u m m a rie s L a b re s u lts p ro b le m lis t A lle rg ie s re co rd s G P re co rd s d is c h a rg e G P event h o s p ita l L is t o f parts of the record 12

Health Informatics New Zealand www.hinz.org.nz Anything else? • Is there anything (other than already indicated above) that you would NOT want available? (You may list examples that don’t apply to you personally, but that you think should be kept private.) Information that respondents would not want shared Mental health issues that may be circumstantial rather than inherent. Could be misconstrued or perhaps viewed unfavourably. Hospital admission for surgery would be fine to be accessed by others. However not hospital admissions such as intoxication. I wouldn't like all people having access to as it doesn't affect my health and creates an area to be judged 13

Health Informatics New Zealand www.hinz.org.nz Information that respondents would not want shared There may be some discussions you prefer to be kept private - perhaps the option of that being on the Central Register? Perhaps genetic records Irrelevant information that would not be applicable to care from another provider Abortion Any private personal issues Lab Results not to be shared I cannot think of anything but if something pops up I would mention it STD's etc may be best kept as an optional choice anything that doesn't directly relate Specific STI's, TOPs etc which may be requested by Insurance companies from a GP and they may feel compelled to divulge info when the individual went elsewhere specifically so that the family Dr would not have info 14

Health Informatics New Zealand www.hinz.org.nz Access to Records Would you be happy for the following groups of people to have access to your records? • your general practitioner • practice nurses • after hours doctors • other general practitioners • hospital doctors (includes emergency department, outpatient clinics, specialists, doctors on the ward if you are an inpatient) • hospital nurses (includes emergency department, outpatient clinics, specialist nurses, nurses on the ward if you are an inpatient) • Physiotherapists • Chiropractors • Plunket nurses • mental health workers • Family Planning doctors and nurses • Vision and Hearing Testers • Dentists • Pharmacists • Alternative medicine practitioners • Yourself • Your family/whanau Allow Access Part 1 100 90 80 70 60 Yes 50 40 No 30 20 10 0 after hours own general other general practice nurse hospital doctors hospital nurses physiotherapists chiropractors practitioner practitioners doctors 15

Health Informatics New Zealand www.hinz.org.nz Allow Access Part 2 90 80 70 60 50 Yes 40 No 30 20 10 0 Plunket mental `Family Vision and Dentists Pharmacists Alternative Yourself Your family/ nurses health Planning Hearing medicine whanau workers doctors and Testers practitioners nurses Holding Records Who do you think should hold your records? Please tick as many as you wish. • the different professionals you see (as now) • your general practitioner • Yourself • the Ministry of Health • a secure electronic site where they can be accessed as required 16

Health Informatics New Zealand www.hinz.org.nz Holding the health record 90 80 70 60 50 Yes 40 No 30 20 10 0 yourself professionals your general the Ministry electronic a secure practitioner of Health individual site health Other comments Survey is quick decision making. A longer time for thought would have been appreciated as there are important considerations to be answered especially with consideration to lower echelon access and all info available to specific professionals when they would only require specific info my main concern would be security of electronic and physical storing of files only if absolutely secure as much information available as possible An electronic site is fine if our nation continues in safety - if it fell into bad hands it could be dangerous and used against people with disability/hereditary illness etc. 17

Health Informatics New Zealand www.hinz.org.nz Other comments I understand this to mean my GP is the 'main' holder of the records with other professionals having access to them Health practitioners who do have access should hold this information as confidential and not be able to discuss this with other peoples/professionals without consent (possibly in writing) I would like it to be secure, i.e. that those people who happen to work within the healthcare industry but don't have a direct input into the patient's care aren't accessing for general interest rather than for individual care Don't mind other professionals having access as necessary Other comments I think that the more info a medical practitioner can have about you the better they would be able to treat you correctly It will be great to have a secure electronic site which all medical practitioners can view including person viewing their own records e.g. id no required, but no access to other members of the public I feel that it is useful for health professionals that adhere to a strict confidentiality code to have records but do have some issues with such a wide variance of people holding the records 18

Health Informatics New Zealand www.hinz.org.nz Hippocratic Oath • What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself, holding such things shameful to be spoken about. (Classical version) • I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. (Modern version) Recent developments in the UK • Much money being spent on improving IT systems • NHS Connecting for Health – NHS Care Records Service – Choose and Book, electronic booking service – Electronic Transmission of Prescriptions – National Network (N3) – broadband connectivity and IT infrastructure – Contact – central email and directory service for the NHS – PACS Picture Archiving and Communications Systems – IT supporting GPs, including QMAS, QoF and GP to GP record transfer 19

Health Informatics New Zealand www.hinz.org.nz Pre-requisites for Shared Electronic Health Records • In general practice – Ability to electronically transfer notes between general practices – Excellent search tools – Smart decision support tools – Training in the use of the technology 20

Health Informatics New Zealand www.hinz.org.nz Pre-requisites for Shared Electronic Health Records • In the hospital – Clinical notes on the computer – Electronic referrals and discharges Pre-requisites for Shared Electronic Health Records • In general – Dialogue with the people of New Zealand as to what they want – Solving the privacy and security issues – A national approach which constructively involves all the stakeholders 21

Health Informatics New Zealand www.hinz.org.nz Recommendations • Ask the patients • Develop a system that allows for individualised permissions • The shared electronic health record should be accessible to patients • Ensure that the pre-requisites have been dealt with • Have a national approach with decision-making which involves all stakeholders • Don’t forget the Hippocratic Oath 22

Sharing EHRs - A GP and patient perspective

by Health Informatics New Zealand on Apr 03, 2010

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Sharing EHRs - A GP and patient perspective — Document Transcript