20220314 Patient access to records and understanding from April 2022
- 1. Patient Access Evergreen Life PHR NHS App Patients may be able to access their GP electronic health records from April 2022 • Why did we do this? • How can we do this responsibly and safely? • What safeguards did we put in place? • How can we safely redact information in the record ? Haughton Thornley Medical Centres has enabled full Records Access and Understanding including free text to the whole record since 2004 Over 10,000 patients (81% of the patient population has done this) Monday 14th March 6:30pm till 8pm Dr Amir Hannan Full-time General Practitioner Haughton Thornley Medical Centres www.htmc.co.uk @amirhannan
- 2. Fears for patients and practices • Practices will get overwhelmed with demand • Patients will expect errors to be corrected • Patient will not understand their records • Patients will increase demands • Something terrible will happen • Practices will get sued • 3rd Party / Harmful data will get shared • Practitioners will get referred to the GMC
- 3. One day in 2003…. Example photo – not a true patient
- 4. Challenges Long waiting times Demoralised workforce Cost of living going up for all Living with covid – not yet post covid Over-worked under-valued
- 5. Patients, carers and information are the most under-utilized resources the NHS has
- 6. HTMC Mission Statement There for you all your life, your good health with our support, empowering you to live well Managers provide the context for patients, carers and clinicians to excel
- 7. Opportunities Smartphones, tablets and computers available Maturity of apps / app stores Wifi / broadband General Practice front door now digital
- 8. Facts and Figures In 2020 in Great Britain Percentage Have internet access 96% of households % of adults who have shopped online 87% Internet connections in households with one adult aged over 65 80% % of adults used internet banking 76% Accessed 20th February 2022 https://www.ons.gov.uk/peoplepopulationandcommunity/householdcharacteristics/homeinternetandsocialmediausage/bulletins/internetaccesshouseholdsandindividuals/2020 Accessed 13th March 2022 NHS Digital – Patient Online Services https://digital.nhs.uk/data-and-information/data-tools-and-services/data-services/general-practice-data-hub/patient-online-management-information-pomi
- 9. Amir Hannan & Glen Griffiths October 2011 Create interest Engage Inform Activate Manage relationship Reactivate Build momentum Flying, EMPOWERED patient Safety netting The EMPOWERED patient Part of Shared Decision Making
- 12. Expanding remote monitoring at home Partnership of Trust Partnership of Behaviours Partnership of Responsibilities
- 13. Practice-based web portal www.htmc.co.uk
- 15. Learn more about how to look after yourself during Ramadan when fasting https://tinyurl.com/HTMCRamadan
- 16. Patient Access Evergreen Life PHR NHS App
- 17. Screenshots taken from the Test Patient record: https://tinyurl.com/HTMCTestPatient Evergreen Life PHR Patient Access
- 19. Electronic health record Extended Access Hub OOHs Urgent Care EPACCs A&E Summary Care Record EMISweb Ambulance, 111, District Nurses, Single Point of Access EPACCs PCNs Whole electronic health record read / write with consent Would you mind if I look at your electronic health record ? Artificial Intelligence Responsible Sharing
- 20. Electronic health record Extended Access Hub OOHs Urgent Care EPACCs A&E Summary Care Record EMISweb Responsible Sharing Records Access and Understanding Safety Checklist Explicit Consent Questionnaire Would you mind if I look at your electronic health record ? NW Ambulance, 111, District Nurses, Single Point of Access EPACCs Artificial Intelligence PCNs Whole electronic health record read / write with consent
- 21. EXPLICIT CONSENT IS KEY
- 25. What is our process? • Assume all patients / carers can have full access • Engage your Patient Participation Group • Patients are informed, engaged and activated in the consulting room • To get the full “records access and understanding” • Complete Safety Checklist questionnaire • Opportunity to answer any questions • Check GP electronic health record • Add code “Patient Remote Record Access Enabled” to active problems list • Switch on all the subcomponents for full records access including free text from 1/1/1900 (for EMIS practices) • Send an MJOG multimedia-rich message to the patient informing them • Email their pin numbers to them if not already been given them • Inform them they can email the practice if they have any issues • Publish our data every Sunday to monitor the improvement • We have trained our receptionist to do this and provide support for digital services
- 26. Practice-based web portal www.htmc.co.uk Click here to see the latest data showing how many patients have access to their records
- 27. Writing in the notes Do • See this as an opportunity to help improve understanding for all • Use templates for common conditions / advice • State clear facts and when you are stating an opinion • Follow up with links to signpost to trusted information • Provide local information how to get the best from the practice / local services • Refer to previous notes and check if info was useful Don’t • Make assumptions you cannot back up later • Use abbreviations • Dumb down or over-simplify • Use doctor speak (unless you know the patient understands) • Write untruths / lies for fear of repercussions
- 28. Main exclusion • Unable to provide consent • Dementia • Digital Divide & no family / carer • No time / resources to devote • (Lack of interest) Problem areas • Severe mental illness • Child protection
- 29. How to manage 3rd Party / Harmful data at point of care • I will try to remember what you say • There is an accusation that Mr Y did….. • Mrs X says Mr Y did…..
- 30. Redaction software / tool • Software can help but not “automatic” • Redaction needs to be end to end tested • Needs to be foolproof • Long list of concerns / challenges eg GP to GP • Relies on human interaction – hence WILL FAIL • So MANAGE the risk…..
- 35. To share or not to share….. • BUT biggest risk is not sharing…. • The Paradigm Shift in Healthcare
- 37. MJOG Messenger
- 38. Engage Consult
- 39. For latest data at Haughton Thornley Medical Centres please see https://tinyurl.com/HTMCPatientsWhoCanReadDocNotes
- 40. Type of patient How many have signed up % Total patients 10,700/13059 81% Diabetes (type 1 & 2) 809/979 82% Type 1 Diabetes 72/74 97% Prediabetes 828/1016 81% Cancer 351/439 79% Depression / Anxiety 3510/4068 86% Carers 396/443 89% Heart disease 367/464 79% Pregnant 79/80 98% Learning disability 62/82 75% Bengali patients 1440/1611 89% Asthma 1718/1977 86% COPD 304/409 74% Medications ordered online 3729/13059 28% COVID19 positive 2674/2916 91% For latest data at Haughton Thornley Medical Centres please see https://tinyurl.com/HTMCPatientsWhoCanReadDocNotes
- 41. What can other providers do? • Some correspondence may be harmful or not shareable • Clearly mark on all correspondence if information / letter they are sending has: • Harmful data • 3rd Party data • Should be redacted • Think about whether information needs to be shared or can be kept within internal documentation with the opportunity for people to contact you if need be – manage the risk!