Political "Top-Trumps" and GP Record Access

No postings for more than 10 months - and no-one noticed…..

I have moved from GP partnership into the world of a 'Portfolio' GP, maintaining clinical practice at my former surgery, but working for HSCIC across a broader remit to link projects and programmes closer together, for patient and clinician benefit.

In England there has been consistent work going on 'behind the scenes' leading up to a flurry of activity in March to activate online interaction between citizens and General Practice. So with the publication of achievement figures today, there is a sense of surprise and amazement that the landscape of opportunity for citizens has changed so much.
Of course the sceptics will argue that 'only' around 5 million people are currently registered to use these types of service, and that very few yet go as far as to access the medical record elements.
While that is true, there are several markers of a 'step change' in attitude to the opportunity, approach and demand for digital interaction with Primary Healthcare services:

• General Practices themselves turned on the functionality - a positive attitude
• NHS England and GPSoC worked to educate and enable - facilitation NOT enforcement
• Improvements in Patient Facing Functionality - a market waking-up to opportunity
• BMA commitment to work with NHS England - constructive dialogue to expedite benefit
• Alignment with future strategy - Five year forward view

So I am very optimistic that General Practice IS leading the journey of discovery about how citizens and Health & Social Care services can effectively and safety interact in a virtual environment. We all need this to work, to mitigate the politically unpalatable reality of demand outstripping the resources we currently have, without radically new different ways of working.

Digital interaction, with supported self assessment and management, improved signposting and the effective delivery of a virtual service to support healthy choices and rehabilitation, is a major part of the ambition in the next 5 years. Without it the Health and Care services may well soon sink under the burden of 'wants' and 'promises'.

Health and Care services are there to deliver what citizens are assessed as needing, in a manner that is as acceptable and convenient to citizens as possible. Time to move on from Political 'Top-Trumps' to utilise digital interaction to improve the quality and safety of health and social care.

PS - Social Media Hermit…..

Memories of a great teacher

This week General Practice mourns the loss of Professor Sir Michael Drury, former RCGP president, professor and teacher at Birmingham University.

He was part of a 'double-act' with Dr Hull that provided most medical students at Birmingham a first glimpse of medicine, patients and future career options from a GP perspective. They were known affectionately as 'Dreary and Dull', although the teaching style was far much more progressive and challenging than ward based traditional methods.

From those early encounters I learned the important cornerstones to clinical practice of 'active listening' and the very special relationship between a patient and a trusted clinician. They have been important to me throughout the 30 years of my clinical practice.

But how do these principles fare in an era when we are moving towards more digital interaction, remote access, patient empowerment and control?

Well the evidence on uptake of digital Primary Care services is very biased towards clinical initiation and support being the key enabler. So where doctors, nurses and clerical teams take the lead, patients are far more likely to engage, use services and gain benefit. My own experience is that there is little expressed demand for 'control' where a relationship of mutual trust and involvement exists, but there is an increasing interest in using new technology to get information such as results and linked advice quickly and conveniently. Perhaps this is the 'control' I should be working on?

So we are working on registering as many patient as possible to have an opportunity to digitally interact, and we want to record patient communication preferences so that we can start to use the technology to keep patients informed, updated and able to safely self-care. As an increasing proportion choose a digital channel as the default first contact, we have new opportunities to educate, sign-post and support without further demands on Primary Care staff that are delivering beyond a safe and sustainable capacity.

There are risks and challenges, as outlined in MDDUS pointers this week in a GP medical publication, but without clinical leadership and development in partnership with patients, the temptation for political and strategy interests to dictate and micro (mis)manage will be irresistible.

Disruptive technology through electronic interaction between citizens and care providers is here to stay, and will increasingly change the way we expect to work and manage health. But I believe we need to maintain and enhance relationships between clinicians and patients, and not to give up ‘active listening’ in favour of computer algorithms!

PRDS

12/06/2014

Slow progress & New targets

Well General Practice has begun to settle into a new year of shifting targets, altered priorities and 'initiatives' to change the service for the better!
Sadly for front-line service, no-one seems to have altered the increasingly dependant culture in society to seek advice for any potential ill, woe, grievance or disappointment that does not resolve within minutes.
My own medical degree, 6 years post graduate training and regular updating is no longer the main underpinning of front-line practice. It would probably have been beneficial to more presenting patients had I done a combined Dentistry and Social Work degree!

But for all patients registered with my Practice aged over 75, help is at hand with new requirements in the GP contract - being allocated a nominated and accountable GP. (By June 2014 - so Record Access relegated AGAIN as a priority.)

As one of my trusted colleagues put it to me this week - "I do think sometimes politician’s think a bit of spin will solve the world. What do they think GPs have been doing for 50 years but providing personal care to their patients. As if a “nominated accountable GP” will suddenly make everyone well!"

For an average practice like my own this causes unexpected challenges. As the longest serving partner but with a part-time commitment, I have a proportionally larger share of patient for whom I am recorded as the 'usual GP'. In fact to achieve an equitable (and manageable) share I will have to inform 149 patients that 'another' GP is allocated as responsible and accountable for them. Perhaps not a way to enhance my reputation and build long term relationships - but without this sharing of responsibility a large slice of my clinical availability will be swallowed by this worthy initiative.

But perhaps I am 'old-fashioned' - I have always felt professionally responsible and accountable for patients on my practice list - and paid Medical Defence fees accordingly. New directives do not improve capacity for my Practice, in fact they tend to restrict our freedom to prioritise attention on those in greatest need (there are some very fit, well and independent over 75's!).

The law of unintended consequences revealed again?

Peter S.

Difficult times….

No Blog entries for months - has he lost interest, faith, his password or retired?

Well sometimes when things go quiet it is because lots is happening, and sometimes there is just so much confusion no-one has a clue what is going on.

In the front-line world of General Practice the 'demand' for service continues to increase at a frightening rate. EVERYONE is queueing up to land more work at the door, mailbox or 'e-inbox' of General practice. These are daunting, fraught and dangerous times, with no clear end in sight.

The press remains schizophrenic in attitude to NHS services, on one hand 'blasting' the publicised high profile failings, then on the other hand fiercely defending a National Treasure. Clearly part of the long run up to a General Election next year where Health will be a political battle ground.

So what is happening in a 'real' GP surgery, trying to find solutions on a daily basis and deliver a sustainable service? Well we have far too much on to spend any meaningful time to develop on-line services. Even basic transaction support becomes questionable when we have no spare capacity, so harsh but practical decision are made to support any service we feel helps capacity and safety, but to abandon those who do not seem to us to help or at least prove resource neutral.
Our decision:
Transactions actively supported for online medication requesting and appointment reminders
Transactions retained for appointment booking and cancellation
No active support (or withdrawal) for patient access to records

If we are in the vanguard of 'early adopters' for Record Access, what does this type of decision indicate for other practices? Well, we suspect that few will actively promote online activity that costs time, effort and money. We are well aware of the claims and reports by 'enthusiasts' over efficiency to the business, but we have NO capacity or resource to get that far - even if we believed these claims were realisable outside enthusiast practices. Transactions for appointment booking seem to have little value to patients giving 24/7 access when we have 10 days to wait for a free appointment! SO the point is that online interaction we currently have does not add to capacity, and some fear it may fuel unrealistic expectation.

For those who are sceptical of the claims from General Practice I can only report my real-world experience of the last Friday and Monday in GP land. Both were days 'on-call', triaging and seeing those with perceived urgent problems (medical, surgical, dental, social, financial, administrative etc etc), both lasted from 8am to beyond 7pm. No coffee breaks or lunch, and an intense run of 'decision taking' and 'risk assessing'. Having been 'dusted' around by cleaners on Monday evening at 7:20 pm I gave up, to complete paperwork the following day in the early morning before 'work'. Not sustainable or safe.

So the new GP contract from april 2014 promises to incentivise/require GP practices to interact in more modern online ways. But as a service we are close to breaking point in a way none of us long serving providers have seen before. If GP service collapses so does the rest of the NHS. Forcing Online interaction will not be the final straw, but perhaps there are other greater priorities?

Difficult times…..

Continuity & Personal Service

No additions/comments/updates over the summer - pretty typical of the 'behaviour' in GP practices. With more staff on holiday, those who remain are busy with the routine work and NOT with making heroic plans to deal with the expected winter pressures, the next rush of central developments and demands, and the ongoing barrage of NHS criticism.

So what has been happening in our quiet attempts to improve the range of options for digital interaction with patients?

Firstly there is a slow, steady and sustained trickle of new registrations for Online service registration. No great demand for Record Access, but significant interest in appointment and repeat medication ordering. And we believe that some basic publicity has helped!

Second observation is the realisation that my system provider had failed to repair SMS appointment reminders to patients AND continues to report in the record that an SMS reminder has been sent!
Does not inspire confidence that future digital interaction (upon which we plan to increasingly rely), is yet robust enough?

But my most important reminder of priorities happened during a seemingly ordinary 10 minute consultation yesterday, and it has lifted my spirits at the end of the summer holiday.
The consultation in question was with a patient I have known for most of my 25 years as a GP. I was reminded that 22 years previously to the day, I had attended urgently at his home to discover a classical presentation of a 'heart attack'. At the time I carried a wide range of emergency drugs (before Paramedics existed in my area) including morphine (now rarely carried thanks to a former colleague in Hyde) which relieved the urgent situation before departure to hospital.  The intervening years have seen a range of interventions, surgical and pharmacological, but have probably all contributed to a long and active retirement.
I was thanked gracefully and politely, for myself and my surgery continuing to 'care' and provide a service that is appreciated daily.

So for me this is a reminder that care, compassion, responsibility and continuity of care have not started because of recent 'scandals' and 'painstaking reports', or arrived by computerised protocol. They have existed throughout my working life, in all care locations and from all members of the caring and support teams I have worked with. The failures remain the minority exceptions - often when the 'needs of the system' are allowed to override the judgement of those at the point of care.
I must remember that in ANY of my attempts to open up more digital communication and interaction opportunity, compassion is not delivered by a computer, or 'care' by an algorithm alone. It is those who run the systems that must introduce technology that supports rather than detracts from these qualities. Quite a challenge ahead!

Peter S.

Memories

Time flies - and medical students grow into doctors who (sometimes) grow into respectable senior members of the profession.

I look back with rose-tinted spectacles, as on this day 30 years ago, I am reminded that I stepped out onto the ward in a starched white hospital coat as a 'proper' junior doctor.

The unsuspecting patients in Birmingham were not warned or prepared as I assumed responsibility for decision making on a whole new level.There will clearly be differences with the new generation, who may start better prepared, better supervised, less tired and better trained to interact with fellow human beings, but I suspect much of the excitement and trepidation is undiminished.

The 'digital' junior doctor may well not be burdened with pockets full of reference material, may 'clock-off' without a 24 hour duty shift, but will still need to practice and refine what they have started to learn over 5 years about interaction with patients, relatives and colleagues in healthcare. No amount of 'virtual' practice can match real life in remaining a steep learning curve.

So my advice to them is to listen, and engage the brain and heart when dealing with people.

Technology is fun, and essential to use, but can only compliment the essential care, compassion and personal touches that nurses, doctors and all our colleagues provide.

Good luck, and learn quickly. I need you to be looking after me sooner than you think!

Peter S

Expectation v Capacity

It is very hard sometimes being part of such a negative, defensive, pessimistic and cautious profession - or so the 'media' currently paints us in General Practice.

For those with an interest, there is an additional thought provoking publication from the 'Medical Protection Society' over on-line interaction and relationships between doctors and patients - worth consideration.

MPS Guidance

In particular I am concerned of the mis-match between patient expectation on routine response to e-mail enquiries, and the attitudes and capacity in General Practice.

Simply put - more communication channels from the public to General Practice will add to demand and workload unless other work, communications and processes are discontinued. I believe most practices are currently working at or beyond safe capacity, so yes, we are cautious with good reason.

Peter S.

What to do with the 'Information'......

I am going to attend a meeting this week to learn more about 'Information for Commissioning'.

What can Commissioners ask for or expect, what can they do with it and how will it change things?

It should be very interesting and relevant as we glide smoothly (?) into the era of CCGs.

But perhaps I have been living in a different universe from other Healthcare providers for the past 10 years or more. We have no end of data available already, we have 'grown-up' with local comparisons and 'bench-marking', we look in detail at prescribing, referrals, length of stay, urgent admissions, 'frequent-flyers' etc etc. What is so new in the ambitions now being expressed and the expectation?

Well - being the grey-haired sceptic I am, a few observations flow:

• The availability of data to the NHS is far from new - we have always had lots, but seem to be short of time and resource (and sometimes the will) to analyse & understand it, to identify areas of unwarranted variation and to act upon these.
• The data alone does not drive change - despite all the political ambition and rhetoric. 
• The commitment and resource to continually collate, analyse and reflect upon collected data and the information it reveals needs to be embedded within every care AND Commissioning organisation.
• When finances get tighter - we tend to cut resource to analytical staff & processes and 'assume' wrongly that the work can be absorbed into daily activity.

SO the message from a small healthcare organisation with a track record of reflection and action on comparative data is simple:

• Priorities what you look at and start small
• Be prepared to learn by comparison with peers
• Commit resource to data analysis as an administrative and clinical function
• Make changes as a team AFTER analysis
• Review future performance to check desired outcomes

In Commissioning  'learning' Healthcare Organisations at all levels, NHS England and CCGs are not just asking for delivery, they must resource practitioner and organisational level reflective analysis.

In my 'bubble' of digital Primary Care I am nervous that there will be a strong Top Down temptation to 'name-and-shame' those who are slower to embrace policy aims at the front-line, as revealed by National reporting. In a forward looking 'learning organisation' we would help each other to understand the data and the opportunities for change and improvement these reveal. To turn the sticks into carrots... the real power of data......

Peter S.

Well done EMIS

I am not normally known to sign the praises of computer system suppliers - even the one I have used for many years. But this week the company released a small upgrade to the search and audit function that means I can find out much more about how many patients on my list are registered and using the on-line interaction services.

So why is this so important to me?

Well, very simply, without looking at the statistics of patient interaction I may be complacent assuming we have done all we need to meet the demands for on-line interaction, or that such a function is only used by a tiny minority.

So this month my surgery has a registered list of 9,277 patients. Of these 1,329 have an activated account with the theoretical ability to access on-line services such as medication and appointment ordering - accounting to about 14% of the surgery list.
A further 1,630 have had a PIN issued giving them the opportunity to complete registration, but have not yet chosen to complete the process (a further 18%), leaving 6,318 using only traditional services.

There are a few interesting features in the 'activated user' group. 114 accounts are for children under 10, so clearly some parents see advantages of registering their children. In general more females are registered for the service, except in the 60-69 and 70-79 age ranges.

So overall 2 cheers for EMIS who have responded to my request to add search functionality - but they could do much more...

I need to have regular reports produced, without having to devise and build and run hem myself, and I suspect all other practices will want the same with 2013-14 DES targets. More importantly to make an impact on demand at the desk and on the phone I need a more detailed breakdown of how many appointments are booked on-line and repeat scripts ordered on a monthly basis - and who are users of Medical Record Access and messaging.
This information will help the practice to manage workload AND give a better understanding how our services are used and could be developed.

And all GP IT system suppliers are in the same boat. The systems contain highly useful information - just help us as users to get at it please in a way that makes sense.

PS

Bad memories...

One of my cheerful patients on Friday was just off on holiday to Morzine in France, for a family snowboarding trip. All excitement and a precautionary 'check-up' for snuffly offspring before departing.

I remarked that the same location marked my last ever skiing trip location 4 years ago, a fall seriously fracturing my leg, and a painful ten month rehabilitation period before returning to work. Perhaps the 'health promotion' message to take care and wear a helmet will sink in!

But last night for me marked again by unpleasant dreams re-living the event, asking myself 'what if'... to change the outcome.

I have not yet been faced by patients who have experienced harm, of even just mentioned uncomfortable reminders of past events and experiences after reviewing past records and events - but it will happen sometime.

Not a reason to ban the prospect of retrospective access in my eyes, but important to have human sensitivity in dealing with the lingering consequences of past event for our patients.

Peter S

Mobile Apps.....

I go away on holiday for a week, and come back to a 'storm' of news and innovation!

Several companies announced innovations that are increasingly focused on patient interaction and convenience, combined with an increasing focus on what a patient may want and need.

My own system supplier has quietly announced the launch of an 'App' available for android and apple devices allowing booking of appointment, repeat medication requesting and secure communication.

I have tested this out on a 'dummy' record, and it looks like a promising start.

So yet again, exciting times ahead as we see what the market can offer to invigorate and open up opportunity. I very much hope that the direction of development will be towards functionality that enables patients and families to access, understand and use information to make healthy and safe choices with confidence. Like most colleagues in Primary Care, the relentless 'shift' away from Secondary Care without any resource re-allocation is pushing us close to breaking point, and technology on its own is only part of the solution...

Appy Easter

Peter S.

Life as a Hedgehog

It can be uncomfortable and dangerous, living ones life in the 'middle-of-the-road'.

But am I in the foolhardy, spiky minority, am I taking risks?

The debate I follow, and the related ongoing subject of these postings, is the progress in GP practice on-line interaction with patients. And it seems to have been a noisey week in the press and social media!

On one side of the carriage-way are the articulate 'nay-sayers', expounding the risks of a free-for-all with sensitive information, mushrooming workload and a security nightmare. On the opposite side are  the proponents of progress at any cost, predicting doom, gloom and revolution if all the barriers to information access are not unceremoniously torn down immediately....

And so, I 'dither' in the middle of the road, looking both ways, but not really drawn to, or convinced by either camp of the rights and wrongs.
Like many of my GP colleagues, I have rapidly become a user of IT to access services and information that make my life easier and more convenient. I expect to check balances and transfer money on-line, to browse and shop in the evening for presents I have forgotten,  to communicate with friends and colleagues and to plan my family schedule.
But also recognise that I wish to be private and secure with my information, I shred documents and take care of passwords, I update anti-virus software and try to remain alert for security threats and 'scams'. I have been caught out before, and will be again, but on balance I still choose to 'take the risk'.

So am I on my own, in the middle-of-the-road'?

It would appear not! The majority of my colleagues, and quite probably of my patients, can see benefits and risks, but will increasingly try out on-line interaction in health as they do in other areas of their lives. Every practice and every patient will have different reasons and experience - all equally valid.

So it turns out that MOST of us are 'in the road', those shouting from the sides may well be the oddities with entrenched views and less grasp of reality. There really are NO cars or lorries bearing down on us, threatening instant oblivion - there are challenges to face, mistakes to make, evidence be gathered and lessons to be learnt, but not by sitting on the edge lecturing to others.

Being in the 'middle-of-the-road' may turn out to be the cool place to be!

Peter S.

Missed the boat with Records Access?

There are 'delights' of being behind the times with 'IT'. But that is followed by the pain, challenge and frustration of trying to 'catch-up'.

And the NHS is always 'catching-up'!

In a reflective mood I am considering what I need to offer patients this year to make their lives (and mine) easier, safer and healthier. What can I do with the information I hold in trust, with the relationships I have spent so long developing and the clever opportunities that an 'on-line' world opens up?

The easy answer is to follow the innovators and evangelists on opening up records to patients - 'do what I am doing and your problems will be solved'. Or I could follow the bulk of my professional colleagues - 'I am far too busy doing the basic work 11 hours a day in General Practice to take on anything else'.

But perhaps there is a 'third-way' (with apologies to multi-millionaire Tony Blair)? To follow my instincts, trust my knowledge of my patients and my record system and pursue a local pathway to improve little bits of my Health Service provision and interaction - irrespective of National policy, perceived wisdom and the next wave of 'targets'....

And my area for attention may just 'leap-frog' the interest and expectation in Records Access for this year. E-mail is 'old' hat, social media is inappropriate, PCs are dated technology - but 'bite-sized' direct secure messaging may hit the spot!
So how and why have I come round to this view? Observing some of the trends and expectation across all age groups - our society is advancing using smaller and smaller 'parcels' of relevant but fleeting 'information' to make decisions and manage life, often through mobile devices. Who has the time, interest or inclination to 'wade' through long and complex documents to find a 'nub' of crucial information? Ask yourself, when did you last read through the T&C of a software update - or do you just press the 'accept' button and proceed?

In my world THIS is the way forward to share clinical data, recommendations, communication and interaction 'on-line' with an increasing proportion of my patients. It could be done via a medium of their choice (for inclusivity), text, e-mail, letter secure messaging - who knows. It will involve small discrete 'parcels' that are of immediate relevance - the patients can do what they want with it - dismiss in seconds, store or collate - the choice is open and free. Results, advice, updates, reminders, letters, prompts, warnings from the practice - and as we develop functionality comments, suggestions, status reports, questions, values and observations from patients and carers back to us.

Am I on the 'right' lines - who knows?

But I suspect I am not the only one thinking beyond Records Access...

PS

A year of on-line GP practice services for patients

My surgery has been offering ‘on-line’ interaction with patients since 2006. We started with medication requesting and appointment booking, and more recently added access to medical records in November 2011. What follows is a summary of the activity during 2012.

Successful logins	8745
New patients registered for service	227
Appointments booked	2018
Appointments cancelled	591
Repeat medication requests	2468
Address detail change	226
Medical record viewed	115

So what are my conclusions at the end of a year that has seen a significant rise in political interest over ‘on-line’ GP services for patients?

• With a practice list size of 9000 and 6 years of on-line service behind us, we still have an average of less than one on-line interaction per registered patient.
• ‘Transactions’ at the convenience of patients dominate the activity.
• Medical record viewing remains at a very low level without active clinician promotion.
• There is significant potential to increase on-line activity and relieve telephone and front desk pressure with routine tasks such as repeat medication requests and GP appointment booking.

We do not know the age/sex breakdown of service users – this could be informative.

We are uncertain how we compare with other practices

We have not researched the barriers to use by patients

Medical record viewing has not been a major challenge or workload in the previous year.

So – ‘more of the same’, or ‘must do better’?

For serious consideration in 2013:

• Offering nursing and ‘task specific’ appointments
• Advertise the appointment and medication services more actively
• Target specific individuals for Record Access and test result notification
• Press for better activity reporting from system supplier

Happy New (Patient on-line) Year!

PS

Nothing about me without me?....

Christmas over, 'sales' in full swing, New Year rushing towards us, and the prospect of a damp and bleak January ahead...

Bah humbug!

Thankfully the end of the world proved another false alarm and no reprieve from a full surgery, but NHS services in Primary Care we will see a gathering pace towards the changes that accompany Clinically Led Commissioning under the NHS Commissioning Board.
The end of March will also see the formal end of 'Connecting for Health', and reading many commentaries you could easily surmise that few will mourn the passing. But hidden under headlines of inefficiency and misguided strategy are considerable nuggets of success. Of course I am biased - but most of the successful elements had significant clinical influence and 'buy-in' leading to useful and USED developments. I hope this lesson is retained in future structures and plans.

Only two predictions for 2013 in the field of Primary Care informatics:

1) Patient 'on-line' interaction with primary care will increase significantly, with politicians claiming vindication of patient power and clinicians claiming a victory for common sense and professional responsiveness, but primary care services remaining under ever increasing strain to deal with basic reactive healthcare, rising demand and expectation, let alone aspirations for proactive and preventative work.

2) 'Open Data' as an agenda for change using the immense and hitherto lightly utilised primary care database will become a heated high profile debate, polarising opinion and distracting from worthy aims. As a clinician I am struck by the challenge from the single 'headline' within the 'Power of Information' documentation - 'Nothing about me without me'. In terms of individual access to our own GP records this is translated into a right of easy on-line access to our electronic records, but what is the converse implication for central collation and use of 'our' data for secondary purposes as demanded by the 'Patients and Information' directorate of NHS CB? In particular what restrictions do I as a citizen and patient want to see applied to MY identifiable health data?


I do not have the answers to the last question, but add the observation that electronic clinical records usually reflect a private and very personal patient - carer relationship that is appropriate to share  between those parties, but indiscriminate wider sharing (and in particular publication) carries significant risks for this fundamental relationship of trust.

So more interesting times ahead

Happy New Year!

Peter S.

The Good, the Bad, and the Different

Lots on my plate in the last few weeks, so I have taken my eye off Records Access at the surgery. And when you take your eye off - things happen!

My surgery has undergone a system migration this week - never an easy transition, and the first time for us in 19 years. As part of the process there is disruption to Patient Access. Neither of my test patients now have the ability access to Medical Records - I probably need a training refresher here! Not heard if this issue is the same for my patients - but I do expect it to be the same.

The patient interface has also undergone a change - and the Patient Access ID number has changed to a new (longer) one including a practice identifier code. Will probably turn out to be easier, but NOT a memorable number - so patients will have to write it down (as I do), perhaps making it a bit less secure.

On the bright side there is an opportunity to enter a number of security questions - I am assuming these are needed for password re-set remotely. That WILL be an improvement that I must check out!

And last irritation is that the patient information links are not currently working. The experience of enthusiasts and innovators in that patient support and educational information is vitally important to make use of the record. Must do better....

PS

Who will benefit most?

A big question with "Records Access", who stands to gain the most?

The patient, with or without a chronic illness?
The 'digital' surgery?
The affluent with modern technology and smartphones?
Advertisers and the IT industry?
Politicians claiming vindication?

No clear answer(s) at the moment.

Attending and contributing to an evening talk in Lewisham on Record Access sponsored by The Health Foundation has contributed to my knowledge and made me consider the potential to support citizens with diabetes more effectively. It is always good to have a mixed audience of patients, health care providers and local managers, polarisation of opinion is reversed, and some real progress can be made in awareness of mutual opportunity. The 'myRecord' project in this locality will be well worth watching as a locally owned and driven initiative to use technology to support care better.
Perhaps those present have shown/reminded me that the technology use is not just to improve care, rather to enable and encourage better SELF-care.

My second 'lightbulb' moment around 'on-line' services for patients comes from consideration of how patients may get access to test results, using new technology. A much repeated and topical government and policy aspiration.
For me, there are still significant barriers for many of the population to bother to search records and review results - it is likely to be a minority activity EVEN with enthusiasts. But to mis-quote many historical figures - perhaps there is 'a third way'!

My inspiration is to use technology to assist the current process, not to invent new pathways or generate more work for General Practice. We already have swift return of results through electronic laboratory links, and in most surgeries these are rapidly reviewed, commented upon, actioned where necessary, then filed into GP records. There are already very efficient mechanisms to confirm results belong to the correct patients, despite the 'distrust' of some senior officials, and trusted processes to deal with important results! What is missing is a way to convey the result and clinical interpretation/advice directly to the patient. Currently most GPs write, telephone or instruct patients to contact the surgery to check results - an inefficient process for all of us, patients particularly.
The solution? Immediate 'one button' option to copy the result AND the clinical advice/comment via the channel chosen by the patient - an SMS message to mobile phone or e-mail are equally possible. (US Blue Button' concept). And before there are too many complaints - we already pay for NHS mail and SMS text messages through N3. There are some issues around such a proposal - but all are simply soluble IF we have a will to do so. Perhaps such a solution makes getting test results and supportive advice a lot easier and quicker than the cry for 'full record access' can deliver? It could then easily extend to other 'bite-sized' bits of information - Immunisation status, hospital letters, consultation notes....

So lots to ponder - but a solution to message my patients securely would save me an hour or two a week.... and probably more than that for my patients.

Are you paying attention GP system suppliers?

Peter S.

Hearts & Minds

I have just returned from a GP system user groups conference, filled with enthusiasm, new ideas and ambition - that is what these events are about. But through the buzz of new announcements and promises there were three distinct 'threads' that relate to 'Records Access', and my small scale experiment in opening records.

The first, and probably the most important is that the general professional resistance to this proposal has significantly reduced, with a shift to apathy or even interest in how it may be done! I suspect the clear policy message in the Information Strategy has had an impact - but there were still practical concerns voiced, and scepticism as to the true demand from patients.

The second was a clear recognition by the company that 'Information' is the clear thrust of their future strategy. Making the record available when, and where needed, information to support clinicians, practices and organisations, and very clearly integrated with high quality information for patient use.

The third more practical promise was of forthcoming improvements to the system functionality, enabling easier administration and delivery by practices, and easier patient use.

All three of these are needed to win the 'hearts & minds' of clinicians, patients and organisations in order to deliver so much more than the simple transaction and viewing services we have now. It cannot be long before all the providers of IT systems to Health & Social care services start to take similar steps - or are required to follow. This is not a race, but an exciting time of opportunity, leaning and innovation! I believe the NHS has the spirit and ideas to innovate using technology, and in partnership with industry - I just hope it is given the freedom rather than constrained by targets and red-tape.

Peter S.

Control....

In the British Medical Journal this week, the lead theme is 'patient control of records', with an editorial comment, main article and personal view.

I have spent a significant amount of time pondering the meaning of 'control'. There does seem to be a wide variety of views and, surprise surprise, no easy answer.

For the most determined advocates, control has been explained in terms of patients 'holding or posessing' the records, determining who and and when the records are accessed and being the central 'hub' for all who request access. The most negative sceptics articulate a very different vision, where the existing organisational medical records are maintained and shared for patient view only with strict technical controls and information governance procedures, in order to ensure confidentiality.

Perhaps most are missing the point - what is it we as patients and 'citizens' expect as control?

For very many of us this elusive ‘control’ is not ‘posession or ownership’ of the record or about asserting our ‘rights’ to  see all the notes about us, but rather a ‘confidence’ and trust in those who care for us – confirmed through the routine ability to see and understand plans and records, should we wish to do so. Most of this is focused on the relationship between clinician and patient and ‘shared decision making’ over all aspects of health and care.

As a clinican in a professional relationship with my patients, I want them to feel comfortable, informed and valued in all our contacts – in other words, ‘in-control’. I cannot always make this happen, but I feel that control is NOT about asserting rights, but rather having the confidence that they are being respected.

Peter S