As practices are grappling with the strain of declining funding, and patients presenting with more complex and chronic conditions, new ways need to be found to provide a safe and accessible service.
With this in mind, NHS England established Patient Online, a programme to help practices harness technology to give patients greater and more convenient access to primary care, and provide GP practices with a more efficient way of working. Patient Online is helping practices to meet General Medical Services (GMS) and Personal Medical Services (PMS) requirements to enable online booking of GP appointments, online prescription requests, and - by the end of March 2015 - patient access to selected parts of their medical record. The minimum for this is the summary data – medications, allergies, and drug reactions.
By empowering patients to take a more active role in improving and maintaining their health and wellbeing, this should not only improve outcomes but relieve some of the pressure on practice staff.
Patients will be able to contact the practice outside of office hours, and may be able to solve their query themselves, by accessing their record, without needing to contact practice staff. The online transactional services may also help to reduce ‘did not attends’ (DNAs).
Patients will still be able to contact their practices by phone, post, or in person, it’s just there’s an added method of communication which will be more convenient for some patients, and should result in a decrease in phone calls to the practice.
Research suggests that it will also improve patient safety by reducing prescribing errors, ensuring greater accuracy and fewer complaints to the practice.1
According to Patient.co.uk, 85% of patients polled supported viewing the medical records online.2 This could be invaluable not only in achieving quality and outcomes framework (QOF) points, but also in health promotion, particularly when there is an existing plan in place, for example with diabetes.
Many practices are already offering online prescription ordering and appointment booking, and are now contemplating online records access. Suppliers delivering the GP IT systems have made switching on access simple, with EMIS claiming it can be done in as little as three minutes. Before you do, however, there are a few things you need to consider:
How much access are you going to give?
Are you going to have a big launch, or a soft launch by perhaps choosing a cohort of patients (the diabetic register is a popular choice)?
How are you going to publicise it?
What resources will you use for this?
There are other more technical considerations such as access for children, identity verification, proxy access and coercion.
When GPs were informally polled regarding providing electronic records access (ERA) for patients, the overwhelming theme was ‘I’m not comfortable about patients seeing everything.’ And this is a perfectly reasonable concern, particularly if a patient has child protection or domestic violence issues. Details need to be recorded somewhere for other clinicians, but it may be inappropriate for the patient to see this. You can still give your patients reasonable access without access to free text.
Practices are not obliged to give access to every patient who requests records. They are also not obliged to give the patient access to everything including free text in consultations. For this year, the minimum is the summary information as mentioned above. You may, however, decide that giving patients access to their test results and perhaps their vaccination record will yield instant benefits to the practice. For example by logging in to their record and checking when the last tetanus booster was recorded, may save a phone call to the practice to check. Likewise, for those patients with chronic conditions, just going online to check blood results may save a phone call or a consultation. It will also enable a patient to be more prepared when they do have an appointment to discuss the results. The ‘expert patient’ concept has clearly shown better outcomes for patients who are more involved in their treatment decisions. By having access to results prior to their appointment, they are better informed and come with questions they wouldn’t otherwise have asked.
Planning your launch
Would you have a ‘big bang’ approach or a ‘soft launch’? The soft launch has the benefit of giving you experience of what works well for you and your patients and what is less successful. With a soft launch, although this may require a little more prior planning, it is less likely to be a burden on reception staff as they will not be inundated with requests on day one. You can be selective with a soft launch – perhaps select a patient group which already has access to your online transactional services; they’re already converted, but can give you valuable feedback and make suggestions. Diabetic patients are also a good choice – many of them are in the 50+ age bracket which is the age group most keen on online access.2 They also stand to benefit greatly from access to test results, with the potential of reducing the number of times they will need face-to-face reviews or telephone consultations. You may consider patients with chronic conditions and when they are invited for their usual review, ask them to bring identification documents with them which can then be verified during their consultation, if they want to have online access. For publicity, it’s a good idea to use those underused resources you already have – your patient participation group (PPG). Many members will be keen to get involved and do something important to help move the practice forward.
Perhaps you might put on an information evening run by the PPG, or have drop-in ‘get online’ clinics with PPG members in the waiting room. You could even have one of them write an article for the local paper advertising your online service. This was done in North Staffordshire to great effect.
As you put your plans together, you may come across some issues that are trickier to handle. What about children? What about coercion? Proxy access? Identity verification? NHS England has been working with the Royal College of General Practitioners (RCGP) to develop guidance on these topics which will be released shortly, and is also currently working on e-learning modules which will provide a quick and easy way to get the relevant facts, guidance and ideas for implementation. It may be that when you are starting out you want to restrict access to adult patients to start with before tackling access for children.
In the meantime, as well as publicity literature to raise awareness in and around your practice, you may like to consider your initial plan, including:
What degree of access are you going to offer your patients? You can start with the minimum summary information, and enable further access at a later date if required.
Could you select a staff member (doesn’t have to be a clinician – or the practice manager) to coordinate efforts and undertake training where required and then cascade knowledge?
How will you launch – big bang or small ping? How will you determine the target group if you’re going for the soft launch?
What is your publicity plan?
How will you review how well the process is going?
Patient online access to records doesn’t need to be a daunting prospect – but if planned and implemented wisely stands to offer both savings and efficiencies to the practice as well as an enhanced level of service to the patient.
Fisher B. Patient Record Access – Making It Work for You and the NHS. London: London Journal of Primary Care; 2011.
Patient.co.uk annual survey (October 2013) [22,785 respondents]