This was a zoom call done on 14th March 2022 detailing why we at Haughton Thornley Medical Centres (HTMC) started to give patients full access to their GP electronic health record and understanding in 2004, what we did and still do, how we did it, what the challenges are that we are facing now in General Practice, the importance of the Partnership of Trust, the practice-based web portal www.htmc.co.uk, how we support understanding by sign-posting to trusted information from the practice, our explicit consent process, what we mean by Responsible Sharing, a description of the consent process that all patients wanting access to their records must complete, some dos and dont's when writing in the notes, how to deal with 3rd Party data (not just redaction), what other providers can do to help when sending notes to GP surgeries including do you need to send everything?, an introduction to the Information Governance strategy for Greater Manchester Combined Authority that has recently been ratified and finally a dedication to Ingrid Brindle who recently passed away and was the Chair of Haughton Thornley Patient Participation Group

1. Patient Access Evergreen Life PHR NHS App
Patients may be able to access their GP electronic health records from April 2022
• Why did we do this?
• How can we do this
responsibly and
safely?
• What safeguards did
we put in place?
• How can we safely
redact information in
the record ?
Haughton Thornley
Medical Centres has
enabled full Records
Access and
Understanding
including free text to
the whole record
since 2004
Over 10,000 patients
(81% of the patient
population has done this)
Monday 14th
March
6:30pm till 8pm
Dr Amir Hannan
Full-time General Practitioner Haughton
Thornley Medical Centres
www.htmc.co.uk @amirhannan

2. Fears for patients and practices
• Practices will get overwhelmed with demand
• Patients will expect errors to be corrected
• Patient will not understand their records
• Patients will increase demands
• Something terrible will happen
• Practices will get sued
• 3rd Party / Harmful data will get shared
• Practitioners will get referred to the GMC

3. One day in 2003….
Example photo – not a true patient

4. Challenges
Long waiting times
Demoralised workforce
Cost of living going up for all
Living with covid – not yet post
covid
Over-worked under-valued

5. Patients, carers and
information are the
most under-utilized
resources the NHS has

6. HTMC Mission Statement
There for you all your life,
your good health with our support,
empowering you to live well
Managers provide the context for patients, carers and clinicians to excel

7. Opportunities
Smartphones, tablets and
computers available
Maturity of apps / app
stores
Wifi / broadband
General Practice front
door now digital

8. Facts and Figures
In 2020 in Great Britain Percentage
Have internet access 96% of households
% of adults who have shopped online 87%
Internet connections in households with one adult aged over 65 80%
% of adults used internet banking 76%
Accessed 20th February 2022 https://www.ons.gov.uk/peoplepopulationandcommunity/householdcharacteristics/homeinternetandsocialmediausage/bulletins/internetaccesshouseholdsandindividuals/2020
Accessed 13th March 2022 NHS Digital – Patient Online Services https://digital.nhs.uk/data-and-information/data-tools-and-services/data-services/general-practice-data-hub/patient-online-management-information-pomi

9. Amir Hannan & Glen Griffiths October 2011
Create interest Engage Inform
Activate
Manage
relationship
Reactivate
Build
momentum
Flying,
EMPOWERED
patient
Safety
netting
The EMPOWERED patient
Part of Shared Decision Making

10. Partnership of Trust

12. Expanding remote monitoring at home
Partnership of Trust
Partnership of
Behaviours
Partnership of
Responsibilities

13. Practice-based web portal www.htmc.co.uk

15. Learn more about how to look after yourself during Ramadan when fasting https://tinyurl.com/HTMCRamadan

16. Patient Access Evergreen Life PHR NHS App

17. Screenshots taken from the Test Patient record: https://tinyurl.com/HTMCTestPatient
Evergreen Life PHR Patient Access

19. Electronic health record
Extended
Access Hub
OOHs
Urgent Care
EPACCs
A&E
Summary Care Record
EMISweb
Ambulance, 111,
District Nurses,
Single Point of
Access
EPACCs
PCNs
Whole electronic health
record read / write with
consent
Would you
mind if I look
at your
electronic
health
record ?
Artificial
Intelligence
Responsible Sharing

20. Electronic health record
Extended
Access Hub
OOHs
Urgent Care
EPACCs
A&E
Summary Care Record
EMISweb
Responsible Sharing
Records Access and
Understanding Safety Checklist
Explicit Consent
Questionnaire
Would you mind if I look at your
electronic health record ?
NW Ambulance,
111, District Nurses,
Single Point of
Access
EPACCs
Artificial
Intelligence
PCNs
Whole electronic health
record read / write with
consent

21. EXPLICIT CONSENT IS KEY

25. What is our process?
• Assume all patients / carers can have full access
• Engage your Patient Participation Group
• Patients are informed, engaged and activated in the consulting room
• To get the full “records access and understanding”
• Complete Safety Checklist questionnaire
• Opportunity to answer any questions
• Check GP electronic health record
• Add code “Patient Remote Record Access Enabled” to active problems list
• Switch on all the subcomponents for full records access including free text
from 1/1/1900 (for EMIS practices)
• Send an MJOG multimedia-rich message to the patient informing them
• Email their pin numbers to them if not already been given them
• Inform them they can email the practice if they have any issues
• Publish our data every Sunday to monitor the improvement
• We have trained our receptionist to do this and provide support for digital
services

26. Practice-based web portal
www.htmc.co.uk
Click here to
see the
latest data
showing
how many
patients
have access
to their
records

27. Writing in the notes
Do
• See this as an opportunity to help improve understanding for all
• Use templates for common conditions / advice
• State clear facts and when you are stating an opinion
• Follow up with links to signpost to trusted information
• Provide local information how to get the best from the practice / local services
• Refer to previous notes and check if info was useful
Don’t
• Make assumptions you cannot back up later
• Use abbreviations
• Dumb down or over-simplify
• Use doctor speak (unless you know the patient understands)
• Write untruths / lies for fear of repercussions

28. Main exclusion
• Unable to provide consent
• Dementia
• Digital Divide & no family / carer
• No time / resources to devote
• (Lack of interest)
Problem areas
• Severe mental illness
• Child protection

29. How to manage 3rd Party /
Harmful data at point of care
• I will try to remember what you say
• There is an accusation that Mr Y did…..
• Mrs X says Mr Y did…..

30. Redaction software / tool
• Software can help but not “automatic”
• Redaction needs to be end to end tested
• Needs to be foolproof
• Long list of concerns / challenges eg GP to GP
• Relies on human interaction – hence WILL FAIL
• So MANAGE the risk…..

35. To share or not to share…..
• BUT biggest risk is not sharing….
• The Paradigm Shift in Healthcare

37. MJOG Messenger

38. Engage Consult

39. For latest data at Haughton Thornley Medical Centres please see https://tinyurl.com/HTMCPatientsWhoCanReadDocNotes

40. Type of patient How many have signed up %
Total patients 10,700/13059 81%
Diabetes (type 1 & 2) 809/979 82%
Type 1 Diabetes 72/74 97%
Prediabetes 828/1016 81%
Cancer 351/439 79%
Depression / Anxiety 3510/4068 86%
Carers 396/443 89%
Heart disease 367/464 79%
Pregnant 79/80 98%
Learning disability 62/82 75%
Bengali patients 1440/1611 89%
Asthma 1718/1977 86%
COPD 304/409 74%
Medications ordered online 3729/13059 28%
COVID19 positive 2674/2916 91%
For latest data at Haughton Thornley Medical Centres please see https://tinyurl.com/HTMCPatientsWhoCanReadDocNotes

41. What can other providers do?
• Some correspondence may be harmful or not
shareable
• Clearly mark on all correspondence if information
/ letter they are sending has:
• Harmful data
• 3rd Party data
• Should be redacted
• Think about whether information needs to be
shared or can be kept within internal
documentation with the opportunity for people to
contact you if need be – manage the risk!

42. https://t.co/DDHIdxe5vj

45. https://twitter.com/i/events/1486130412845895684