Practical lessons from rolling-out web-based PHRs


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Dr Brian Fisher's presentation explores the practical lessons learned from the roll-out of web-based PHRs within his own practice and how they have influenced his predications for the future.

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Practical lessons from rolling-out web-based PHRs

  1. 1. MY BACKGROUND <ul><li>GP in London, retired </li></ul><ul><li>Co-director of PAERS </li></ul><ul><li>Lead for RAC </li></ul><ul><li>60% of practices in the UK can now offer full record access </li></ul>
  2. 2. Practices Hospitals SPINE – summary care record PRACTICE – Full GP elec record A+E Carers OPD
  3. 3. WHAT DO WE MEAN BY RECORD ACCESS, IDEALLY? <ul><li>Patients able to see their full or partial record at will. Ideally: </li></ul><ul><li>The whole accurate, contemporaneous record, available anywhere </li></ul><ul><li>Data information knowledge </li></ul><ul><li>Tailored and targeted health information and decision-support </li></ul><ul><li>Patients entering data of their own </li></ul><ul><li>A portal to a range of facilities </li></ul><ul><ul><li>Advice on improving health and managing disease </li></ul></ul><ul><ul><li>Interactive links to others </li></ul></ul>
  4. 4. THE EMIS/PAERS PROCESS 1 <ul><li>Practice needs to decide to switch on the system </li></ul><ul><li>Photo –ID for individual authentication </li></ul><ul><li>Patient signs consent form </li></ul><ul><li>Pins+passwords </li></ul><ul><li>Off you go! </li></ul>
  5. 5. THE EMIS/PAERS PROCESS 2 <ul><li>No Spine – records are not held in any new place </li></ul><ul><li>Record disappears as soon as the patient logs out </li></ul><ul><li>Practices can exclude past non-coded data </li></ul><ul><li>The patient holds the key </li></ul>
  6. 6. THE LEGAL POSITION <ul><li>DPA : Access can be denied where the information: </li></ul><ul><ul><li>may cause serious harm to the physical or mental health, or condition of the patient or any other person </li></ul></ul><ul><ul><li>may relate to or be provided by a third person who had not consented to the disclosure. </li></ul></ul><ul><li>ICO : this is not a subject access request under the Data Protection Act </li></ul><ul><li>GMC : contemporaneous record sharing is an extension of normal good practice </li></ul><ul><li>MPS+MDU : very supportive </li></ul><ul><li>We need to be writing notes for patient view now. </li></ul>
  7. 7. PATIENTS’ CONCERNS <ul><li>Patient inertia </li></ul><ul><li>Concerns about privacy and security </li></ul><ul><li>Fears about new electronic systems (both technophobia and limitation of skills) </li></ul><ul><li>It’s not our record </li></ul><ul><li>New responsibilities </li></ul>
  8. 8. PROFESSIONALS ’ CONCERNS <ul><li>Increased workload – worried well, too many Qs? </li></ul><ul><li>How will workflow have to change? </li></ul><ul><li>3 rd party information, dangerous information </li></ul><ul><li>Children </li></ul><ul><li>Patients with psychiatric problems </li></ul><ul><li>Technophobia and limitation of skills </li></ul><ul><li>Challenge to the White Knight </li></ul>
  9. 9. 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
  10. 10. BUILDING ON TRUST <ul><li>Errors </li></ul><ul><li>Seeing clinicians’ muddles </li></ul><ul><li>Consultation notes are not a true record </li></ul><ul><li>Information is power </li></ul><ul><ul><li>Handing power to the patient </li></ul></ul><ul><ul><li>They can reinterpret </li></ul></ul><ul><ul><li>They can remind us </li></ul></ul><ul><ul><li>They can correct us </li></ul></ul><ul><li>This is a challenge </li></ul>
  11. 14. BENEFITS FOR PATIENTS <ul><li>Increase self-care, confidence, understanding, relationships with the clinician </li></ul><ul><li>Save patients’ time, making best use of GP and hospital clinic consultations </li></ul><ul><li>Correct inaccuracies in the record </li></ul><ul><li>Improves compliance and preventative health behaviour. </li></ul>
  12. 15. YOU ARE A DIABETIC – WHAT IS POSSIBLE NOW <ul><li>You attend different hospitals and the GP, you have arrays of tests at different times with varying advice that is sometimes contradictory. </li></ul><ul><li>You can keep clinicians in touch with each other if needed by showing them the record </li></ul><ul><li>You can check your test results without calling the practice </li></ul><ul><li>You can check what good practice looks like </li></ul><ul><li>You can share your information with a carer or family </li></ul><ul><li>Information buttons become a personalised health resource </li></ul>
  13. 16. YOU ARE A DIABETIC – WHAT IS POSSIBLE NOW <ul><li>You can order rpt scripts and make appts online </li></ul><ul><li>You’re not clear what the clinician said to you. Look it up! </li></ul><ul><li>The clinician wrote R eye when it should be L. Correct it! </li></ul><ul><li>Look at the letters from the hospital – you don’t need to call the practice for them. </li></ul><ul><li>When does your certificate run out? What are you allergic to? When did you have that immunisation? </li></ul>
  14. 17. PRACTICE BENEFITS <ul><li>Improved trust through transparency </li></ul><ul><li>Saving time – letters and results </li></ul><ul><li>Patients with RA use primary care less because better informed and involved patients have better outcomes and use less health care </li></ul><ul><li>Improved compliance when reminders are in place? </li></ul>
  15. 18. WEB 2.0? WEB 1.5? <ul><li>WEB 2.0 </li></ul><ul><ul><li>User generated content </li></ul></ul><ul><ul><li>Content personalised </li></ul></ul><ul><ul><li>Interactive </li></ul></ul><ul><ul><li>Collaboration and sharing </li></ul></ul><ul><li>I-PATIENT </li></ul><ul><ul><li>Interaction is facilitated </li></ul></ul><ul><ul><li>Collaboration is facilitated </li></ul></ul><ul><ul><li>Personalised content </li></ul></ul>
  16. 19. DEMO
  17. 20. POSSIBILITIES <ul><li>New applications to support self-management </li></ul><ul><li>Patients writing in the record </li></ul><ul><li>Bluetoothed sphygs </li></ul><ul><li>Reminders </li></ul>
  18. 21. This technology is about relationships and trust <ul><li>The power of the technology is dependent on the relationships between clinician and patient </li></ul><ul><li>Primarily trust by clinician for the patient </li></ul><ul><li>But also TRUST BY THE CLINICIAN IN THE PATIENT </li></ul>
  19. 22. LINKS <ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li>Guidelines </li></ul>