History of Patient Record Access
‘Access by patients of their own records is an important corollary of access by clinicians. Only when patients know the contents of their record can they ensure its accuracy and give informed consent for disclosure’
Good practice guidelines for general practice electronic patient records, GPC and DOH September 2003
Dr Brian Fisher, MBE, a GP in South East London has been allowing patients to view their medical records since 1984, originally on paper and more recently in electronic form at a kiosk in his surgery.
More recently the drive to allow patient access to records in the UK has been led by a handful of enthusiastic GPs and patient representatives, backed by innovations from IT suppliers. "I think I have a duty of care to share records with my patients if they wish to do it." says Dr Fisher.
Patients are keen on access, both in principle and practice. Time and again, patients say in the studies that, even if the news is bad, they are keen to see what is being written about them. About 10% of patients find some of what they see distressing, but they still feel it is right and safe for them to see their record. Studies that we have conducted in the practice chime with other international studies to show that patients gain significantly from record access:
- They trust the clinician and the practice more
- They feel more able to self-manage their illnesses
- They feel more confident in the clinical encounter
- They can correct the record and thus improve safety
- There is some evidence that record access improves health outcomes, improving medication compliance in heart failure and improving smoking quit rates
As online access grows, we begin to see other benefits. Since patients have access through any web-browser, they can access their records in outpatients or in A+E, enabling hospital clinicians to see what the GP has already done. One patient became ill abroad, accessed their records online and was provided with far safer care.
Recent work funded by NHS Connecting for Health, as yet unpublished, has investigated how patients use record access via the kiosk. Patients use access to make the best use of time in a consultation. They avoid appointments if they have seen the information they want electronically. They use the data to complete forms. They feel quite tentative, because they don’t see the information as theirs – it feels as though they are peeking over the garden fence into someone else’s territory. If a consultation has been confusing, they look at their notes to clarify what was said.
In summary, record access is safe even in serious illness. It is supported, of course, by the law on Data Protection and the Copying Letters to Patients initiative.