MY BACKGROUND GP in London, retired Co-director of PAERS Lead for RAC 60% of practices in the UK can now offer full record access

GP in London, retired

Co-director of PAERS

Lead for RAC

60% of practices in the UK can now offer full record access

Practices Hospitals SPINE – summary care record PRACTICE – Full GP elec record A+E Carers OPD

WHAT DO WE MEAN BY RECORD ACCESS, IDEALLY? Patients able to see their full or partial record at will. Ideally: The whole accurate, contemporaneous record, available anywhere Data information knowledge Tailored and targeted health information and decision-support Patients entering data of their own A portal to a range of facilities Advice on improving health and managing disease Interactive links to others

Patients able to see their full or partial record at will. Ideally:

The whole accurate, contemporaneous record, available anywhere

Data information knowledge

Tailored and targeted health information and decision-support

Patients entering data of their own

A portal to a range of facilities

Advice on improving health and managing disease

Interactive links to others

THE EMIS/PAERS PROCESS 1 Practice needs to decide to switch on the system Photo –ID for individual authentication Patient signs consent form Pins+passwords Off you go!

Practice needs to decide to switch on the system

Photo –ID for individual authentication

Patient signs consent form

Pins+passwords

Off you go!

THE EMIS/PAERS PROCESS 2 No Spine – records are not held in any new place Record disappears as soon as the patient logs out Practices can exclude past non-coded data The patient holds the key

No Spine – records are not held in any new place

Record disappears as soon as the patient logs out

Practices can exclude past non-coded data

The patient holds the key

THE LEGAL POSITION DPA : Access can be denied where the information: may cause serious harm to the physical or mental health, or condition of the patient or any other person may relate to or be provided by a third person who had not consented to the disclosure. ICO : this is not a subject access request under the Data Protection Act GMC : contemporaneous record sharing is an extension of normal good practice MPS+MDU : very supportive We need to be writing notes for patient view now.

DPA : Access can be denied where the information:

may cause serious harm to the physical or mental health, or condition of the patient or any other person

may relate to or be provided by a third person who had not consented to the disclosure.

ICO : this is not a subject access request under the Data Protection Act

GMC : contemporaneous record sharing is an extension of normal good practice

MPS+MDU : very supportive

We need to be writing notes for patient view now.

PATIENTS’ CONCERNS Patient inertia Concerns about privacy and security Fears about new electronic systems (both technophobia and limitation of skills) It’s not our record New responsibilities

Patient inertia

Concerns about privacy and security

Fears about new electronic systems (both technophobia and limitation of skills)

It’s not our record

New responsibilities

PROFESSIONALS ’ CONCERNS Increased workload – worried well, too many Qs? How will workflow have to change? 3 rd party information, dangerous information Children Patients with psychiatric problems Technophobia and limitation of skills Challenge to the White Knight

Increased workload – worried well, too many Qs?

How will workflow have to change?

3 rd party information, dangerous information

Children

Patients with psychiatric problems

Technophobia and limitation of skills

Challenge to the White Knight

RECORD SHARING DOES REPRESENT A REAL TRANSFER OF POWER Fears of losing control over aspects of the clinical encounter and management of the patient. SOMETIMES, BUT THEY UNDERSTAND THE REASON Patients get upset COMPLEX, BUT RISKS CAN BE VIRTUALLY ELIMINATED Third party information HACKING VERY UNLIKELY IF DISTRIBUTED DATABASE Security and confidentiality NO EVIDENCE OF INCREASED LITIGATION THE ACCURACY OF THE RECORD IS IMPROVED RA will expose clinicians’ data quality and encourage litigation RECORD SHARING SAVES TIME Consultation length RESPONSES CONCERNS

BUILDING ON TRUST Errors Seeing clinicians’ muddles Consultation notes are not a true record Information is power Handing power to the patient They can reinterpret They can remind us They can correct us This is a challenge

Errors

Seeing clinicians’ muddles

Consultation notes are not a true record

Information is power

Handing power to the patient

They can reinterpret

They can remind us

They can correct us

This is a challenge

BENEFITS FOR PATIENTS Increase self-care, confidence, understanding, relationships with the clinician Save patients’ time, making best use of GP and hospital clinic consultations Correct inaccuracies in the record Improves compliance and preventative health behaviour.

Increase self-care, confidence, understanding, relationships with the clinician

Save patients’ time, making best use of GP and hospital clinic consultations

Correct inaccuracies in the record

Improves compliance and preventative health behaviour.

YOU ARE A DIABETIC – WHAT IS POSSIBLE NOW You attend different hospitals and the GP, you have arrays of tests at different times with varying advice that is sometimes contradictory. You can keep clinicians in touch with each other if needed by showing them the record You can check your test results without calling the practice You can check what good practice looks like You can share your information with a carer or family Information buttons become a personalised health resource

You attend different hospitals and the GP, you have arrays of tests at different times with varying advice that is sometimes contradictory.

You can keep clinicians in touch with each other if needed by showing them the record

You can check your test results without calling the practice

You can check what good practice looks like

You can share your information with a carer or family

Information buttons become a personalised health resource

YOU ARE A DIABETIC – WHAT IS POSSIBLE NOW You can order rpt scripts and make appts online You’re not clear what the clinician said to you. Look it up! The clinician wrote R eye when it should be L. Correct it! Look at the letters from the hospital – you don’t need to call the practice for them. When does your certificate run out? What are you allergic to? When did you have that immunisation?

You can order rpt scripts and make appts online

You’re not clear what the clinician said to you. Look it up!

The clinician wrote R eye when it should be L. Correct it!

Look at the letters from the hospital – you don’t need to call the practice for them.

When does your certificate run out? What are you allergic to? When did you have that immunisation?

PRACTICE BENEFITS Improved trust through transparency Saving time – letters and results Patients with RA use primary care less because better informed and involved patients have better outcomes and use less health care Improved compliance when reminders are in place?

Improved trust through transparency

Saving time – letters and results

Patients with RA use primary care less because better informed and involved patients have better outcomes and use less health care

Improved compliance when reminders are in place?

WEB 2.0? WEB 1.5? WEB 2.0 User generated content Content personalised Interactive Collaboration and sharing I-PATIENT Interaction is facilitated Collaboration is facilitated Personalised content

WEB 2.0

User generated content

Content personalised

Interactive

Collaboration and sharing

I-PATIENT

Interaction is facilitated

Collaboration is facilitated

Personalised content

DEMO

POSSIBILITIES New applications to support self-management Patients writing in the record Bluetoothed sphygs Reminders

New applications to support self-management

Patients writing in the record

Bluetoothed sphygs

Reminders

This technology is about relationships and trust The power of the technology is dependent on the relationships between clinician and patient Primarily trust by clinician for the patient But also TRUST BY THE CLINICIAN IN THE PATIENT

The power of the technology is dependent on the relationships between clinician and patient

Primarily trust by clinician for the patient

But also TRUST BY THE CLINICIAN IN THE PATIENT

LINKS www.icmcc.org www.paers.net http://www.paers.net/iPatient_PCT/index.html Guidelines

www.icmcc.org

www.paers.net

http://www.paers.net/iPatient_PCT/index.html

Guidelines