why record access? - ICMCC

icmcc.org

why record access? - ICMCC

EMPOWERING THE PATIENT

WITH I.T

PATIENT RECORD ACCESS

Dr Brian Fisher MBBCh MSc MBE

General Practitioner in London

Record Access Collaborative Lead


AGENDA

• My background

• RAC

• What is record access?

• What is available now worldwide

• Demo

• Benefits+risks

• The future

• A set of questions for you – guidelines

• Who are you?


MY BACKGROUND

• GP in London

• Co-director of PAERS

• Lead for RAC

• UK has an integrated 1y care system

• Which is more or less paperless


RECORD ACCESS

COLLABORATIVE

• Brings together people across the world

with an interest in patients having full

access

• Industry, clinicians, managers

• Doing research and disseminating it

• Links with www.icmcc.org

• Raising the profile, making the case


WHAT DO WE MEAN BY

RECORD ACCESS?

• Patients able to see their full or partial record at will.

Ideally:

• The whole accurate, contemporaneous record, available

anywhere

• Data information knowledge

• Tailored and targeted health information and decisionsupport

• Patients entering data of their own

• A portal to a range of facilities

– Advice on improving health and managing disease

– Interactive links to others


I am a working mum looking after a small child, a part-time job,

a husband, a house… I also have Diabetes, an under-active

Thyroid, fertility problems, depression, asthma and recently

started medication to protect my kidneys!

I don’t have time to be ill!

I now order my prescriptions, book my appointments to see the

doctor, check my test results and sometimes I even go over

the conversation I had in my consultation with the Doctor when

I feel I need to clarify issues.

I shop online, I communicate online, I educate myself online, I

control my finances online. In 2007 it’s only right that I look

after myself ONLINE.


WHY RECORD ACCESS?

AUTONOMY, RESPECT

EFFICIENCY

• In the UK, it’s a patient’s right. GMC supports

openness and transparency.

• There are significant patient and clinician

benefits

• The patient is a neglected resource

• Shared decision-making reduces costs and

improves care. People need information to do

this.

• Fragmentation of care – the patient and IT as

the glue

• Access may change relationships for ever


SYSTEMS

• In the US, there is a plethora of systems

offering almost full RA

• Graphnet and diabetes

• Connecting for Health

• Renalpatientview

• E- HealthCard

• PAERS/EMIS - REACH


A patient about

to look at their

records


DEMO


BENEFITS FOR PATIENTS

• Increase self-care, confidence,

understanding, relationships with the

clinician

• Save patients’ time, making best use of

GP and OPD consultations

• Correct inaccuracies in the record

• Improves compliance and preventative

health behaviour.

• Helps patients understand consultations


The shift in culture and

performance

• Carers in Australia

• A test that had not been followed up

• A reinterpretation of a clinical history

• An advocate for care in mental health

• An accident in the USA


FUTURE POSSIBILITIES

• Patients adding data,

– co-production of content

– medical history and pre-filling templates

• Reminding patients of appointments linked with

their specific needs

• Links with telecare

• Translation and audio

• Efficiency gains

• Email consultations

• Shared decision-making


This technology is about

relationships and trust

• The power of the technology is dependent

on the relationships between clinician and

patient

• Primarily trust by clinician for the patient

• But also TRUST BY THE CLINICIAN IN

THE PATIENT

• There are risks


BUILDING ON TRUST

• Errors

• Seeing clinicians’ muddles

• Consultation notes are not a true record

• Information is power

– Handing power to the patient

– They can reinterpret

– They can remind us

– They can correct us

• This is a challenge


PROFESSIONALS’ CONCERNS

• Concerns (real and perceived) about liability risk

• Perceptions of adverse effects, including

increased workload

• How will workforce and work processes change?

• Concerns about staff training/regulations about

scope of work

• Technophobia and limitation of skills

• Challenge to the White Knight


PATIENTS’ CONCERNS

• Patient inertia

• Concerns about privacy and security

• Fears about new electronic systems (both

technophobia and limitation of skills)

• It’s not our record

• New responsibilities


BEE’S POEM

To be allowed to access my “bits”

To read results and to see all the

letters,

Makes me feel calm, to my

lifestyle it fits,

And from now on, can only get

better.

This “add on” part of my progress

report,

I’ve welcomed with an open arm,

All problems and worries, now I

can sort,

I won’t come to any great harm.

Of course it’s all new,

I’m learning each day,

What I can read, what is my due,

And how I keep going down this

important way.

I love the idea that you are

trusting me,

As I am, having always trusted

you.

We’ll be able to talk about things

that are relevant,

Check that every body

knows………


POLICY AND GOOD PRACTICE

GUIDANCE

• Absence of policies to increase the

transparency and accountability of data

use

• Absence of guidance generally

• Concerns about the distribution of payoffs,

inequity

• Absence of information about the

sustainability of the value of integrated

PHRs


GUIDELINES FOR WICKED

ISSUES

• Children

• Should we exclude any class of patient ?

• Third party information

• Errors

• Litigation

OVER TO YOU….

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