The Power of Information

The Government Information Strategy has been published, and comments and analysis started to circulate.

While the high level strategy attracts general support, it will be the detail of delivering the reality at the sharp end of the NHS where we all be ultimately judged. Will it make a difference to me as a patient or me as a health professional?

I very much hope so!

My lessons in providing access for patients at my surgery are changing my views about what I would like for myself and my family.

My wish list:

• Easy registration for on-line services
• Electronic booking and cancellation of appointments
• Checking and updating my address and contact details
• Order my repeat medications
• Appointment reminders (if I choose)
• See and print my test results and recommendation from my GP
• A simple 'routine' message service to show that I have seen results and recommendations
• See my future agreed test or review schedule
• See my current Summary Care Record
• See and check my GP summary as kept by the Practice
• See the latest hospital letters about me
• See where I am in 'the system' when referred to a specialist

I would like the reminders and appointment functions to work on a standard 'Smart-phone' - the others can be from a PC or tablet device.

I have though rather more about other information such as older letter, the full record, an audit trail of who has seen my record, e-consultations etc, but these are not currently things high on my priority list. A significant reason is that I trust the GP surgery that looks after me, and the clinicians and staff who work there. They are not perfect, but I am not intending to use 'Records Access' to check up on them, rather to make their job of looking after me easier, and reminding me what I need to do to look after myself and stay healthy - from the convenience of my desktop or mobile phone, 24/7.

Perhaps I will change my mind when I get a regular reminders to get off the computer, to walk a bit more, to reduce my intake of wine and to attend for my scheduled 'health-check'....

Peter S.

Feedback from patients starts...

Last week marked another milestone in the experience of Records Access at my surgery, direct feedback from a couple of my patients.

While I have had copies of my initial survey returned, this is the first time I have had the chance to learn directly who is using the facility, and a bit about their experience.

One patient had clearly been having problems accessing the record, and then later been blocked altogether with password problems requiring a re-set. While this is only a technical issue, it is perhaps a warning that this may become a frequent event. For patients who only look at part of the records occasionally, or who rarely need to book appointments or request medication, forgotten passwords will become a barrier to use. For the practice we are very reluctant to take on additional work with re-setting, particularly when there appear to be efficient and safe mechanisms deployed in the commercial world. Clearly an area where we need to do better to make access smoother.

A second patient had far more success, and had been looking through the record with interest. The questions brought about the presentation of the record from a patient perspective has alerted me to some of the anomalies that I take for granted. This includes the absence of values when they are low or high and 'out of the laboratory range', and instead they arrive from the laboratory as text. Then they no longer appear as a 'value' - which can be very confusing for a patient who knows they had a test on a specific date, but cannot see a result! Also very useful was the observation that a previous significant diagnosis was not listed in the significant problems section of the record. Checking back revealed it was noted in the past record, but not correctly flagged as a 'significant event' due to subsequent improvements and standardisation of our 'summarisation' arrangements. This is now corrected, and gives me an immediate example of where a record summary, jointly managed by patient and clinician, is more accurate and relevant for future care.

So the message of the week - the GP record summary holds important and useful information to support the safe care of the patient, but its value and accuracy is increased when jointly managed by the GP & patient in partnership.

Peter S.

Could do SO MUCH BETTER!

Fascinating statistics available on how my practice population currently use electronic access, and the picture nationally from the EMIS system provider.

At my surgery in March 8 people accessed their medical records electronically, with 17 viewings in total between them. We had 28 new people sign up for access to basic transaction services. 198 appointments booked and 69 cancelled in addition to 180 patients requesting repeat medication. Not exceptional - but a steady flow of activity.

Now if that activity were translated into all GP practices in England (adjusting for list size) every month there could easily be:
1 million appointments booked on-line
356,000 appointments cancelled on-line
930,000 repeat medication requests on-line

And a lot of the activity from patients using on-line services IS during the working day - so surgery staff can attend to other priority patient care and quality service related work.

Below is a graph that shows the EMIS average on-line access activity hour by hour.



More than 70% of the activity is during the routine working hours - very similar to my surgery experience.

So although I am exploring access to GP records electronically, it would seem that any effort to encourage more use of the basic transaction services at my surgery - or any others, is a clear winner as a priority! And when we take the next steps with FAR MORE interested on-line customers?

Peter S.