The future of Patient Online
Dr Ralph Sullivan, Clinical Lead for Patient Online
By 31st March 2016 practices will be required by GMS contracts or PMS arrangements to promote and offer their patients online access to coded data from their records. This builds on access to book appointments, request repeat prescriptions and access data on allergies and adverse reactions and is the latest step on the path towards meeting the commitment given in the 2010 Department of Health white paper: Equity and Excellence: Liberating the NHS to “enable patients to have control of their health records.”
Improving patients' access to their health records is central to providing patient centred care, and encouraging self-management of long term conditions and multi-morbidity. The independent Inquiry into Patient Centred Care in the 21st Century, established by the College, recognised the benefit for patient care in continuing the development of online access to include the full health record, including, where appropriate, free text. In 2014, the National Information Board report: Personalised Health and Care 2020, proposed that patients will be able to add to their own records by 2018.
The College is actively engaged in providing guidance for members on how to implement Patient Online access. In 2013 the College published Patient Online: The Road Map, which established what could realistically be offered currently and in the future to improve patient’s involvement in care and improve their experience of general practice through using Patient Online. We have subsequently completed the first phase of work on guidance for practices collaborating with NHS England. It covers the safe implementation of transactional services that enable patients to book appointments and request repeat prescriptions on line, and access to summary information in line with the 2014-15 GMS contract, the Patient Online Practice Toolkit.
The Toolkit contains guidance documents and e-Learning materials on identity verification, information governance, patients’ responsibilities, and access shared with third parties including the risks to patients if they are coerced into sharing record access with malicious partners or carers. There are checklists for implementation and templates for patient information leaflets, and an online access registration form. The aim is to cover what practices need to know to set up new online access systems and register new patients for access, including new staff roles and training, patient education and safeguarding.
In the first quarter of 2016, the College will publish guidance to help with the new contractual requirement to offer access to the detailed coded record by April 2016. The extension of record access creates interesting new opportunities for patient centred care, and the management of long term conditions - but also new challenges for practices.
It will probably also require a reappraisal of the practice approach to data quality. Practices must take care to carefully screen the records and redact, hiding from online display, data that may be either harmful to the patient or confidential data about third parties that the patient should not have access to, although this will place a new burden on practices. GP computer suppliers are developing systems that make it possible to hide data from online display. This might be used to temporarily redact potentially upsetting information about a suspected diagnosis until the practice has been able to discuss the information with the patient.
The College guidance complements the training materials provided by GP system suppliers and materials for practices and patients published by NHS England. It is available to members and non-members on the RCGP elearning website.