GPs in England are required by their contract with the NHS to offer and promote online access to the detailed coded records to their patients. Each supplier has interpreted the requirement slightly differently. NHS England summaries the requirements in the image below.
Practices may also provide online access to the full medical record. This may be helpful for patients who have complex health needs and want to keep up-to-date with care plans and hospital reports. It may also replace the need to provide paper-based subject access request reports (SAR) commonly requested by patients for legal purposes.
In describing to how manage and make use of full record access, the guidance looks forward to the implementation of the
National Information Board goal that patients will have full record access by 2018.
Clinical use of record access
Patients can use record access as part of routine clinical care to self-manage complex health conditions, meet their personal health goals and achieve better health outcomes. Examples include:
- using access to coded laboratory results to monitor long-term conditions and prepare for consultations
- using the coded data recorded by the practice to check on immunisations, adverse drug reactions, allergies, screening and preventive procedures and preferences and advance decisions recorded in care plans
- reading clinical correspondence from hospital admissions, outpatient appointments and investigations to gain a better understanding of their health and care
- using portable access to the record on tablet computers or smartphones to share data with other health professionals in all health settings.
In concertinas 6-9 of the toolkit there are clinical exemplars to illustrate the clinical benefits of using Patient Online to support a collaborative, person-centred way for patients to manage their long-term conditions. The
Journal of Medical Internet Research recently published a paper on the impact of online services for patients in Sweden. Reasons for access related to patient empowerment, involvement and security.
Providing online record access - the challenges
Providing record access is not straightforward. It does present a number of challenges for practices. Here is a short reminder of the steps to take to meet them:
There is more detailed guidance about managing new applications for record access here:
Data Quality
The quality of data in a patient’s record can be assessed by the extent to which it meets the various purposes that the record is used for. For online services this means that it must be clear and unambiguous for the patient to understand, without displaying information that might be harmful to the patient or others or confidential information to third parties. Poor data quality may confuse or mislead both patients and clinicians and have a negative impact on the patient’s health care and safety.
It is not normally easy to know which patients have record access and it is impossible to know who will have it in the future so it makes sense to develop a practice plan to maintain data quality that is fit for sharing.
Sensitive Data
GP records sometimes contain information that is confidential information about a third party which the patient must not see. There may also be information that may harm the patient, a diagnosis, abnormal result or opinion that the patient is not aware of. It may also contain information that the patient believes is mistaken or wants to have removed from the record. For brevity we refer to all such information as 'sensitive data'.
Patients or their proxies may ask for entries to be altered or removed if they disagree with them or find them upsetting or offensive. However, all health professionals have a right (and a duty) to make complete records of facts and their professional opinions about their patients’ health, indicating clearly which are facts and which are opinions.
All GP systems have a method of preventing data being visible to patients with online record access. This is generally known as data redaction. Before record access is switched on all the data (detailed coded or full record access) that the patient will see should be checked for sensitive data that needs to be redacted. It is helpful to establish a practice record keeping policy about recording and redacting new entries of potentially harmful and confidential third party data even if they do not currently have online record access.
Supporting information - test results
Supporting information - children and young people
Supporting information - coercion
Supporting information - evidence of the benefits of record access to patients