Joint with Understanding Patient Data, this is our third blog on the benefits of enabling people to access their health records. Dr Amir Hannan, GP, describes how it’s normal to access electronic health records and understand them at Haughton Thornley Medical Centres.
Patients at Haughton Thornley Medical Centres (HTMC) have been able to view their full GP electronic health record and gain a better understanding of their care for over 14 years. Currently 63% of all our patients have signed up. As a GP in this practice I, along with the patients and staff, wonder how we ever managed without it.
We work in a very deprived neighbourhood with our fair share of mental health problems, alcohol and drug abuse, child protection and other safeguarding issues and have a large Bangladeshi population. It’s challenging when resources are tight and needs are continually rising.
HTMC is an outstanding GP surgery with patients contacting us for advice on common things ranging from coughs and colds, long term conditions, infections, end of life care to immunisations.
On paper, we are no different to the thousands of other practices giving patients high quality care. Except there is a difference. All patients are encouraged to sign up for full access to their electronic health records and invited to understand their care better, for example:
- A patient is encouraged to go online and see their blood test results, using Lab Tests Online to understand what they mean, as soon as they are available. And not have to book another appointment just to find out it’s normal.
- A patient referred to the hospital can see the GP electronic health record and the referral letter. Then if the letter has been misplaced, they can log onto their record and show the referral letter to the clinician themselves along with the related consultations including free text.
Partnership of Trust
Patients come to their doctor or nurse to get the best care possible. The clinician also needs to trust the patient to tell them as much as possible about what is wrong with them and what they have tried. The clinician can view the patient’s record to see what problems they have, previous consultations, the results of tests and letters from other specialists. In order to enhance the relationship with the patient, we encourage all patients to see and understand what the clinician can see and hence form the Partnership of Trust.
Explicit Consent
Our patients, and their carers, are asked if they would like access to their full GP electronic health record as part of their care. This leads to shared decision making. The patient does not have to try and remember everything. They can become active partners in their care. As clinicians, we know the context for our patients. It’s our responsibility to explain to them why they may benefit from patient access and understanding of their records. Patients complete a Records Access And Understanding checklist questionnaire, which helps them to consider the key issues including challenges as well as benefits. Our receptionists or other staff members can help alongside the clinicians.
Responsible Sharing
All patients should have the opportunity to view their electronic health records. Every encounter is a teaching moment to enable them to do so. When they present in other care settings, for example Out of Hours or A&E, they are in a better position to provide consent to share the record as they have seen it themselves beforehand. We call this ‘responsible sharing’ whilst recognising not every patient will want to do this. All patients should have the opportunity to do so and all staff should be able to help where possible.
Continuity of Care is important
With more patients living longer and with multiple co-morbidities, it is becoming increasingly important for patients to see somebody who knows them beyond just their record. As patients gain a better understanding of their healthcare needs, they can manage simpler tasks themselves such as ordering prescriptions on time, booking in for regular blood tests, checking when scans are back or reviewing what their doctor or nurse has said. This means if they do need an appointment they can choose the right person for them and make best use of their appointment. This is particularly important for those with more complex health and social care needs. We’ve known examples of when patients check their records in the waiting room before an appointment so they are fully prepared.
The future
Consultations are already changing from reading off the screen - what patients can just as easily read themselves - to spending more time focusing on planning for the future and gaining a shared understanding. We plan to build on the work we have done on enabling patients to complete medical histories before they come to see us, encouraging patients to be better prepared at sharing their data with others and more importantly share the knowledge gained. We encourage other GP practices to get started too, sharing our model and experience, so not only patients benefit but also the GPs and teams supporting them.