Oh so slow.....

Confession time - too busy to actively promote the service at present.

Result - nine requests for Records Access to date, and only one fully processed.

Main blocker - me, the staffing and administration of the process!

Action - pursue current interested parties to fully implement RA for them.

Constraints - staff sickness limits my current ambition and expectation.

Concern - what would we do if this became a 'target'?

Requirement - GP system software that makes RA administration easy.


Conclusion - Snow Patrol are excellent in concert.......


Peter S.

Lessons from Kaiser in USA on Records Access

Fascinating Webinar on wednesday with the US team leading Records Access for patients in the Kaiser Permanente organisation.

In 2010 they had 2.5 million appointments booked on-line, 12 million e-mails, 10 million prescription repeats and almost 30 million laboratory tests - covering 8.8 million patients.

Points I particularly noted:

• KP developments have been transaction led, and activity increased year on year
• Significant investment in integrated support information for patients through the portal
• Appointment/medication transaction activity does NOT shame UK
• On-line record access is ‘Results’ focussed and basic non-urgent communication
• Communication is via controlled, not 'open', e-mail
• UK advocates have already gone WAY beyond the Kaiser Physician comfort zone with consultation details etc
• Listen to, respect and address concerns of the (many) professional ‘Nay sayers’
• They do not have specialist appointment booking – we DO (C&B)
• E-mail contact workload does build, and is clearly causing increasing concerns
• 3 e-mail contacts/year per on-line patient, 800 per year per physician in 2010
• Need to integrate RA with daily workflow tasks
• They share concerns over release of ‘harmful’ test results
• KP wrote all the content (much exists for us in NHS Choices and other accredited resources etc)
• Webex attendees tend to represent those already keen on Records Access...

So we can learn things from them - but our Heath Economies are slightly different, perhaps they can also learn from us!

So my personal 'learning points':

• Support Records Access with information patients can use to make a difference to health
• Be very cautious about opening an additional communication channel without clear aims and spare resource
• Listen and respect the views of nervous and sceptical colleagues, and learn together
• Build on the fantastic UK availability of electronic GP records to offer appointment, tests results and medication ordering as widely and quickly as possible

Why not have a look at what KP offer below?

https://healthy.kaiserpermanente.org/html/kaiser/index.shtml

And lastly...

From the cost and activity figures given by KP compared to NHS public data I have compiled the table below from 2010, to give me a rough idea how the NHS is in comparison... (Shoot me down if I am wrong)

	Patients (million)	Spend (£ billion)	Spend per patient (£)
Kaiser	8.8	27.9	£3,170.45
England	52.2	97.1	£1,860.15

I have always thought the NHS gives value for money, no matter how hard people knock it. It remains a 'National Treasure'.

Peter Short

Another perception-reality gap?

Some weeks I read medical magazines & journals and wonder at the effort we put in to the accumulation of 'irrelevant' knowledge. But this week I have been stimulated  and challenged by a number of articles in the BMJ, if you are fortunate enough to have access, links are provided below.

Shared decision making - BMJ 2012;344:e256

Where will Records Access fit in to enhance shared decision making, and help to close the 'perception-reality gap?

Matters of Life & death and quality of life - BMJ 2012;344:e775

Will it just be the 'major' items in Health records that interest patients, or are there things that to clinicians appear trivial, that patients will consider important to understand and address?

Stop the medicalisation of old age - BMJ 2012;344:e803

Will patient and advocate scrutiny of records suggests that we (clinicians) often pursue targets/protocols and guidelines rather than the informed best interests of the older people we treat?

More questions to ponder......

Then again - I could spend all my time debating the issues and questions and be to busy to change anything or try for myself.....

Peter Short

On a more POSITIVE note!

Sometimes the 'conservative' attitude of GPs in England attracts negative publicity, but this approach can shift in a relatively short space of time.

I am very encouraged that the GPs political body has had a recent debate on 'Records Access', reported in the medical press, but perhaps not fully reflecting the new willingness to be involved in resolving the challenges to make Record Access beneficial for patients and the Health Service.

They do point out some of the issues to address before they would be able to support a widespread rollout, these include:

• Third party information - conforming to Data Protection Act requirements
• 
  
• Record understanding - assistance for patients to understand and use a clinical record
• 
  
• Security & confidentiality - confidence in getting the balance right
• 
  
• Control - understanding risks and benefits
• 
  
• Patient recorded entries - learning about how this will become possible and safe
• 
  
• Cost benefits - how will we show that the benefits are worth the effort of patients & clinicians

In the 'Information Revolution' consultation all of the same issues were raised from different parties, so perhaps my professional group are not so 'conservative' after all?

A more positive way to move towards friday - which will end with a Snow Patrol gig!

Perfect end to a challenging week?

Days when 'Access' in bottom of my agenda....

There is no doubt in my mind that there is NOTHING like a full day of front-line clinical practice to put in perspective the challenge that we face in allowing new and innovative ways for patients and citizens to interact with their Health advisors.
After eleven and a half hours at the sharp end of 'undifferentiated illness, uncertainty and discontent' with hardly a break, I am shattered and drained of sympathy and enthusiasm. The benefit of 28 years of experience, grey hairs and a generally mild manner has not protected me from the pressure of 'trying to do the right thing', non-stop on the conveyor belt of General Practice.
And all-round the country tomorrow, my colleague GPs and Nurses will start again with the same routine.

Am I really very inefficient?
Should I 'free up time' to analyse what I should be doing differently?
Why do I find it so difficult to adopt a 'low appeasement strategy' advocated recently by  a respected mentor?
Is this sort of experience and combination of feelings the reason why so many of us are reluctant to consider the combination of Records Access, virtual consultations and expanding communication channels?
We just have difficulty imagining how we can fit it all in........

Answers on a post-card.

Peter Short

Records Access & 'The Big Picture'

Well the Christmas & New Year 'disturbance' is over - and life in the land of General Practice returns to normal (chaos) - amid the wind and rain, heated public debates over health, and ongoing economic gloom.

And will 'Records Access' solve the dilemma for the NHS of increasing demand, tighter financial limits and ever closer scrutiny? Probably not.... No DEFINITELY NOT.

So where does it 'fit in' to future healthcare evolution? Well there are interesting debates going on in many circles, and perhaps that is in itself a sign of change to come, a willingness to consider a more mature and interactive relationship, utilising new media and information sharing opportunities. And as ever there will be polarised views, those who resist 'risky and unsound change without an overwhelming evidence base', and on the opposite side the evangelists who find it hard to understand and sympathise with an often conservative profession that has real concerns about the risks and implications of radical change. So in the middle ground sit the majority of practices, interested to learn more at their own pace, nervous that they have no spare capacity for new 'innovations', and uncertain when and how to proceed and how access fits into the big picture of health and social care.

On top of the list of questions seems to be 'will Records Access' deliver benefits? And here the answer may at the moment be 'not on its own'.
So if not in isolation - what role may it play and why should we consider it?

Well the evidence so far in the UK and Internationally seems to suggest to me it may have an important role to play when combined with actions, transactions and communication. With the record, if we just 'look at it' little changes, the lesson of digital expansion and the internet is that the ability to 'do things' could radically move the agenda forward. GPs have learnt this lesson painfully over 25 years, moving from paper to electronic records - the exciting bits are when we 'do thing's with records - exchange information, audit, decision support and many other 'digitally enabled' functions. So perhaps I should worry less about 'Records Access' as a subject or target and start to think about the opportunities for efficiency and innovation, how this first step enables self-care, healthy choice awareness and to have the data to populate their own 'healthcare management' system and do other thing beyond my current experience and imagination.

So as I work to stimulate interest from selected patients in my surgery I do so with a realistic expectation that 'Records Access' is not my goal, but more likely to be a step in the right direction to patients taking back some of the burden, responsibility and interest in their own health, and in doing so to help me look after them better.

It's good to have ambition!

Peter Short (glass-half-full)

Wonders of Webex

Did a Webex yesterday with DHID encouragement - to outline my rationale for Records Access and the slow progress to-date.
Pleased to have some positive comments and suggestions back, but I am well aware this is the start of a complex development that both excites and worries my profession.
Next week I will have to plan my strategy to 'target' patients in earnest.

I will also be following up a suggestion to audit the age range of patients using transactional services - more homework!

Peter Short