Welcome!
Welcome to the UK Patient Record Access blog!The goal of this blog is to offer patients as well as clinicians the possibility to give their view and experiences on Record Access on an independent platform.The goal of this blog is to offer patients as well as clinicians the possibility to give their view and experiences on Record Access on an independent platform.This platform has arisen from the general ICMCC portal on Patient Record Access and has become the inspiration for other national discussion platforms.
The goal of this blog is to offer patients as well as clinicians the possibility to give their view and experiences on Record Access on an independent platform.This platform has arisen from the general ICMCC portal on and has become the inspiration for other national discussion platforms.We hope you will enjoy taking part in our discussions.
Lodewijk Bos
President ICMCC
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on Friday, August 25th, 2006 at 4:46 pm and is filed under Articles UK, Patient RA.
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The Record Access Collaborative (RAC) is a group of people and organisations all of whom feel that enabling patients to have access to their full electronic GP record is of importance”
THE AIM OF THE COLLABORATIVE
Congratulations to ICMCC on starting an international site to discuss and review patient accessed health records. I hope this is part of a global development of record access within the WHO e-health strategy. The WHO however does not currently include patient access to their own records as part of their strategy. Can the ICMCC see a way to help to change this and will record access be part of the 2007 ICMCC conference?
Richard Fitton
Glossop Derbyshire UK
Patient access to their own records is happening NOW for the privileged few. What stands out is the mutual respect and co-operation between the GP and the Patient working together as a team to improve the standard of care for the patient (or relative) within the surgery, hospitals and within the community.
It is so good to be one of the few!
Yvonne Bennett
Hyde, Cheshire, UK
I am lucky enough to have been part of a pilot group (service development manager at a GP surgery) in England where patients are able to view their records on-line.Each patient involved in the pilot group has given examples of how beneficial the access to their records is.
Examples:-
- Validating the records (correcting where necessary)
- Viewing before consultations
- Viewing after consultations (confirming what was discussed)
- Looking back at their records when a particular complaint occurs again (enabling them to see how this was treated)
The work that is being done in this area is fantastic and the more patients that are involved to drive this project the better.
Keep up the good work
Rob Anker
Glossop, Derbyshire, UK
I think patient access to the medical records is good, but not revolutionary – it really only brings us up to what any of us can do now with electronic banking. Its great advantage is that it allows patients to see the clinicians’ world – which may not necessarily be that pretty.
What would be better still would be to let the clinician see the patient’s world, so that they could start relating to the patient’s needs rather than just the clinical problem. What if we actually recorded patient-oriented outcomes as the norm rather than the exception in a rare research project. We could understand better how to deliver care that really helped the patient as well as having far better evidence about what our usual practices did to patients. Perhaps then we would get less variation in the quality of care and some impetus to reducing the acceptance of poor quality standards in healthcare.
Gathering meaningful data from the public may not be easy, but is not impossible (after all we do just about manage to get it from clinicians and they are difficult enough) – patients generally have a real incentive to contribute. The data may be more subjective and variable in quality (though there is some evidence that patient-collected measures are more ‘representative’).
Hopefully this may stir some comment and discussion
Peter
Singleton
Judge Business School, Cambridge, and University College London
Peter, you make a good point. But I need clarification about what you mean as to how best to enter the pt’s world. Do you mean something like a pre-consultation process: pts write the problems they want to discuss before the consultation themselves ? Or perhaps they would write what happened at the consultation at the same time as the doc? Or they would be able to put their requests and needs to the practice at any time?
Brian Fisher
My first time using the online electronic heath record viewing system I found it great and was able to check my recent Haemoglobin blood test result then go on to further check that the figure given was within the prefered perameters, by being able to do this it has given me a quick answer to what usually is a much longer process.
Well done in getting this going.Will their be a section for local technical and national issues e.g Healthspace (CfC) and EMISAccess (PAERS) integration in the UK?
Chris
would be a good idea! do you want to make the kick-off?
Lodewijk
Peter,
I totally agree. In my view, this is one of the aspects the EHR is meant for. However, in the USA they are trying to split the medical and the patient input into 2 different systems. I will get back with more information on that in the coming weeks on the portal.
It would be good if we could get the discussion on patient input going in this blog.
Lodewijk
The following comment from a patient came in:
“My first time using the online electronic heath record viewing system I found it great and was able to check my recent Haemoglobin blood test result then go on to further check that the figure given was within the prefered perameters, by being able to do this it has given me a quick answer to what usually is a much longer process.” (name known to the administration).
A patient of mine who has recently been diagnosed with diabetes has also signed up for “records access” over the internet. He had some initial blood tests done in the surgery and waited for the results to come through. On Thursday night, he logged onto the computer and saw the results for the first time. This included his HbA1c which came back at 6.5%. However the results page indicated that “normal” was less than 5.5% and underneath the result it came back as “abnormal”.
The patient was concerned about this but decided to wait until the morning and asked for a telephone consultation with me. I contacted him and we discussed the blood test and the fact that it was described as “abnormal”. He did not appear overly anxious about it but did want to know what I was going to do about it.
I enquired whether he had had a look at the information sheet I had given him at the time he signed up for “records access” and whether he had tried to find out any thing more about the blood test. He had forgotten about the sheet so I asked him to have another look at it (and e-mailed another copy just in case he had lost it). I then asked him to try to find out what he could about HbA1c and that I would call him back at the end of the day to give him the “verdict” on his HbA1c.
He looked at the information sheet and realised that there was a web-site - http://www.labtestsonline.org.uk – that ought to give him the relevant information. However when he tried that web-site, it took him to some sort of web auction. (He thinks he probably typed it in incorrectly). He then tried the NHS Direct web-site and did not get much further. He then went to http://www.patient.co.uk and typed in “Diabetes”. He then typed in HbA1c and did a search. From there he was able to find that HbA1c in diabetic patients should be between 6.5 and 7.5 and felt reassured.
When I rang him later in the day, he was very happy to have found the information himself and knew nothing more needed to be done.
We have an empowered patient who has now logged his experience on the http://www.icmcc.org blog. For those of you that want to have a go, why don’t you try this exercise yourselves and see if you can do what he managed to do!
Amir
PS: The patient is aware of this discussion. I explained to him that I could have simply treated him as a “child” and told him the result over the phone. But by involving him in his care, he was able to find information for himself but at the same time I had a duty of care to ensure he understood the meaning of his results and that he was being managed safely based on the guidelines appropriate for clinicians (and patients!) working in the UK.
2 points about access to records
1. viewing results
i think there is a feeling about “caveat emptor” about patients viewing results and not having the knowledge to interpret them ,the feeling being that if they are not able to handle the anxiety caused by this they should not be looking
In my experience as a psychiatrist, the people most liley to misinterpret info in a catastrophising manner are the people most likely to seek it.
Thre are two ways to handle this. One is post results to be seen real time eeven before they are screend by their doctor etc. Abnormal results would need to be coded simply in order to give some basicl level of info to the patient as to what to do with result eg “red” means needs urgent medical attention within 24 hours, “amber” means unless contacted by your docotr with 72 hours about this result seek medical attention”, “blue” means similar but time frame of 7 days and “green” means similar but 28 days. The onus would have to be on the result provider eg biochem lab to colour code the results and they may resist this as they would bear responsibility for correctly labelling results as well as extra admin load.
I thikn the best way to handle this would be to post results AFTER they have ben screened by a health care professional and perhaps a similar colour coded system as an add on
2. Third party confidential info (inof given by a 3rd party about the patient on the basis that it should not be revealed to the patient) should not be accesible online by patients but could stilll be kept part of a secure electronoic record. There would need to be a failsafe method involving manual and electronic methods. Manually when people are scanning or placing records on the online record they should remove the 3rd party confidential info to the secure part of the record. The electronic method would be using a coded phrase eg “XXXYYYZZZ”" bracketing the 3rd party info, the “reading” software could then cut the bracketed info and place it inthe secure (to the patient) folder along with an identifier to the documentt it was removed from. the “reading” software would also be need to able to remove a whole document if necessary to void leaving a “ghost blan” document alerting the patient to the presence of possible 3rd party info and working out by date/time who it was sent it. the major problem in using this coded header/ footer would be in getting universal adoption by others of the same code
What is the current status of patient pre-visit info entry? Is any company offering a program that will allow patients to put in complaints and symptoms prior to the visit, thus priming the doctor for the encounter?
Hi Dr Huda
You raise some very interesting issues that I am grappling with in the practice as my patients get full access to the full electronci health record – warts and all!
Some background stuff first – as clinicians we all see a certain spectrum of patients – as a psychiatrist you see one end of the spectrum, as a GP I see another spectrum. Some could argue that as a GP I see them all but I am sure there are a number who come no where near me – those who are self-managing (over 90% of the population) and those who are on your psychiatric ICU. It will be almost impossible for us to have different rules for different groups of people. So we need to try to identify a generic solution for all. Traditionally that was the paper record in the GP surgery that has all medical information and separate sets of notes in the hospital setting for psychiatry and another set of notes for everybody else. Do people agree with this or is there a need for different views depending on the setting in which the patient is in?
If information is hidden from view, there may be unintended consequences. My biggest fear is that it could enable a clinician to hide information from the patient that could cause the patient more harm than good. Psychiatry is a good example because it can breed fear and anxiety in patients who already suffer with a mental illness. Should such patients be given permission to see what is recorded about them and how they are being treated “for their own good”? When I as a GP am asked to “section” a patient of mine (ie take them away from their home environment for psychiatric treatment against their will for their own best interests because they are significantly mentally ill as defined in the Mental Health Act) I have to conduct an interview with the patient independent of the psychiatrist and inform the patient why I am doing what I am doing even if they do not understand because of their illness. This is also recorded in the medical notes in case questions are asked in the future and also because this is part of the management plan of the patient during this particular episide of illness.
Should results be “held back” until the clinician has acted on them? patients often get blood tests during the day which are then reported on late at night. Occasionally we get a phone call at the Out-of-Hours service (when the surgery is shut) informing the clinician that a blood result has come back that is highly abnormal eg potassium level 6.7 or haemoglobin 6.3. Often there is no other history attached and so the receiving doctor who is working at the out of hours has no idea what the context is – a blood sample that has been taken 2 days ago and so the red cells have haemolysed releasing potassium into the blood sample and hence giving an abnormally high reading or someone who is going into kidney failure and needing urgent treatment. Hopefully the patient will have been fore-warned about the blood results prior to the test being taken and so adequate consent will have been taken. I have described in this blog about a patient who did not know what HbA1c meant and had to go looking for the result. I could argue that the patient should have been given such info prior to the blood test being taken so that he would know what to do with it when he got the result as soon as he got it.
This is the kind of “cultural change” that we are now experiencing in the practice as we start to understand the true implications of records access. Web-site designers may also want to consider the needs of such patients and a site that purports to help patients with diabetes may make HbA1c more prominent as we realise a patient’s educational need! From a “clinical governance” perspective I would rather allow all information to be made available as soon as possible rather than “hiding” it in an in-tray where it is of no use to anybody. However there could be a caveat attached to the result saying “waiting for action” or “acted and normal” or “acted – needs further action, please contact the practice” etc. This would alert the patient and any other clinician either in the practice or outside it to the status of that result.
“Third party info” is really hard. This is where a wife rings me up to say “doctor, you are seeing my husband tomorrow for some ‘benign’ reason. I thought you ought to be aware that he is drinking excessively”. Should I as a GP record this in his notes? If I do then he will find out what his wife has said and then get angry with her. If I don’t write it down in the notes, then I might forget when he comes to see me. I could write it on a post-it note (paper next to me) but what if he actually ends up seeing one of my partners instead? I had a meeting with some Bengali patients of mine yesterday to try to understand how we should approach this problem. Again there are no fixed rules but we thought the best thing to do would be to ask the wife what I should do – should I record this in his notes, should I write it on a piece of paper or should I try to remember this fact whilst recognising that I may forget. I personally do not like the idea of trying to use an IT system that hides information from the patient becuase it creates distrust between my and my patient (the doctor-patient relationship) and I may be colluding with the wife. (What happens if the wife is a vindictive person and is actually lying???)
These are many different threads in one e-mail but would love to hear what different people think. Could you please indicate in your reply what sort of person you are and where you are replying from as I have indicated in my reply as it can help us all understand what perspective you are coming from
Thanks for sharing your ideas so openly. This is very helpful.
Dr Huda,
1. I agree. On balance, I think it best that the doctors make a comment on the result before the patient sees it. We have had patients seeing their records for over 20 years and we’ve tried it both ways. A comment can be simple: “see doctor”, “discuss over the phone”, “normal” and so on. It makes life much simpler. But of course, it may delay patients seeing their data.
2. I agree, again. 3rd party info MUST be kept out. Dr Hannan’s solution is a good one. I usually use such a situation to urge the 3rd party to discuss it with the index pt. Also, I say that it is important for the health of the index pt to include the data in the notes and are they aware of that? I don’ thave to identify where the info came from.
Brian F
To: Todd Lang
Yes, there are 2 compnaies at least who make this possible. One, in the UK is called GePmail. It enables pts to drop into the notes any data they want. The other is a compnay called, I think, Instant Medical History. This has an extensive program which enables an in-depth history to be taken, through interactive questions.
The PAERS company which is developing online records for pts in the UK will also make it possible for pts to record info. But that is a bit in the future.
Brian F
Brian
How do you deal with letters that come from the hospital or another source that include 3rd party data. Do you scan such letters in and make it available for patients to see in your surgery or over the internet? At present I do allow this but warn patients before they sign up for “records access” that they may come across 3rd party data.
I can change the way I record information in the notes to one as you describe. But what do I do with someone else’s letter who is not aware of these issues? We had our first local Care Record Development Board meeting in Tameside & Glossop PCT yesterday. Clinicians, informatics managers, PCT managers and patients came together to discuss these issues and try to understand what this means for the local health community. Those from the mental health trust had some real concerns particularly because of the legal standpoint. But there was a real tension between the “rights” and “needs” of an individual (index) patient and those of a system that says “3rd party data should not be shared”.
The ability to share electronic records has led to a significant paradigm shift in the way health care could (and in my case IS) being delivered. We now need to urgently reassess what this means for patients, clinicians and the system. I am pleased to hear that the ICMCC is holding a conference in June when perhaps we may be able to bring together views from throughout the world and try to develop some consensus on a way forwards.
I am pleased to say the local Care Record Devlopment Board felt very energised but with a weighty burden upon its shoulders.
3rd party info given on basis of confidentiality:
although the patient may feel they have right to access this patient the person who gives it has a right to confidentiality.
they may fear a breakdown in their relationshipwith the patient (95%of the time), rarely they may fear for their safety
Most clinicians do not act solely on basis of 3rd party info but weigh it in the balance when assessing a situation along with other info they may gather eg examination of patient/ blood tests
people with mental disorders for a variety of reasons do not always give the full picture when you see them: lack of insight, embarassment, wish to avoid stigma, scared of being admitted, not wishing treatment etc
In the case of a wife reporting her husband isa heavy drinker, then it signposts a variety ofactions Dr hannan could take such as checking a GGT, looking for macrocytosis on the FBC etc as well as a prompt for him to discuss extent of alcohol use with the patient. The info given by the wife may indeed be malicious but it could also be truthful and relevant to the presenting condition or an opportunity to prevent further health problems by discussing the problem
If a record system does not allow us to record 3rd party info confidential from the patient we would need a parallel system to record such info (as an example the “post it” attached to the paper record or a second record system not acessible online). The use of “hidden” parallel systems is more likely to lead to problems of not being able to acces info through additional steps but also increased mistrust by patients (a known unknown is less threaening than a hidden unknown).
the person who decides the info is 3rd party confidential is the person who gives the info so you have already discussed with them the pros and cons of making the info 3rd party confiential
To repeat: if 3rd party confidential info is not to be stored as such on an online record we will need a parrallel system to record it which is partially defeating the advantages of an online health record
what happens if the system does not allow separate “silos” of information. From a clinical governance perspective, I would want all information to be available for the clinician to help them come to the “right” conclusion about how to manage a condition. Information stored in different places raises the risk of the right information not being available. I often work at the Out of Hours service and see my patients in that setting too.
Is it right that I act in one way in one setting and yet differently in another setting? As patients are registered to access their records on line (with no filtering of information) they are warned that they may come across 3rd party data. Of course the person giving data as a 3rd party is not consented for this – it would be almost impossible to do this for all situations and all patients. Is it enough for me to warn people that this may happen and then to try to manage and contain such a problem as and when it arises.
Of course the systems we have in place at the moment (paper based records) are not infallible either. We encourage clinicians to ensure all 3rd party data has been extracted before patients are able to scrutinise records. But by trying to provide a “perfect” system inevitably mistakes happen and patients get to find out things that the system may have wanted them not to. I am now suggesting that we should make information available even if it may cause some harm to some people but for the greater good for the majority.
the question is whether society is ready for this or not? In our society where we encourage patients to make choices about the treatments they receive, it is important that as much information about their health is shared as possible so that they have as many cues about their health as possible (possibly including those from a 3rd party source).
It is a difficult subject and after reading what the BMA say and other countries counterparts, unfortunately the final choice seems to rest on the doctors shoulders. However in the scenario you gave us about the wife informing on her husbands drinking problem I would say that the informant should make the choice. Between doctors, consultants etc. The choice should be an informed decision between the professionals based on the circumstances of each individual case, even the data protection act seems to follow this idea, albeit with numerous get out clauses. Obviously this will rest a very heavy burden on the above people as even the legislators don’t seem able to put their ideas unambiguously. As to how to hide the information I think that the I.T. people would be able to come up with more ideas than me. I hope this has been helpful.
the problem is about giving this 3rd party confidential info to the patient is you are breaching the trust of the person who gave you the info in confidence. Do we have that right?
i do not think so particularly if you expose the info giver to a possible adverse consequence
the “open info” policy is desirable but not an absolute right to trump all other rights
as I’ve said if there is no provision to keep this info confidential from the patient then it will need to be stored on another system if possible with all the inefficiencies and possibilities of this info not being used
the other alternative is to not use this type of info at all, which would could have serious consequences in mental health. if the online reocrd is therefore potentially useless to us in this field we will end up not contributing to it much
further to the above comments about 3rd Party info given on basis of confidentiality, in England and Wales:
The Data Protection (Subject Access Modification)(Health) Order 2000 (SI 20000/413) exempts health records from the general right of access where such access would be “likely to cause serious harm to the physical or mental health or condition of the data subject or any other person”.
(quoted from Bridget Dolan, “Medical records: Disclosing confidential clinical information” Psychiatr. Bull., Feb 2004; 28: 53 – 56.)
In other words if we feel disclosing this info may cause harm to the info giver (eg such a causing difficulties in their relationship with the patient) then we have a statutory duty to withhold it from the patient on online records
what happens if a patient is warned off the POSSIBILITY of 3rd Party Data in their records if they sign up for on-line access to records and the potential consequences this may cause?
Let’s give an analogy. We know that over 3000 people died in road traffic accidents in the UK last year. We know that getting into a car is potentially dangerous because we may die IF WE DRIVE RECKLESSLY. But what are the rights of a passer-by who gets knocked down as a result of car going off the road at speed. Should this rare eventuality prevent all of us from using cars?
The key point is about whether we as a society should now let all patients see the whole of their records. Patients and the public are now increasingly wanting to see their whole record which may include 3rd party data. This has consequences for the whole medical profession, but as you quite rightly say for psychiatry too. Does this mean that psychiatrists suddenly withdraw writing to GPs and patients what they are doing? Is that acceptable?
I have now instigated a simple solution to 3rd Party data in my own practice. When a fiend or relative contacts me about something relating to a patient, I offer that individual 3 choices:
1) Record in the patient’s record what the relative or friend has said
2) Write it on a post-it note (ie time limited usually less than a week and only to be seen and therefore of use to me alone but with the proviso that I may still lose it)
3) I try to remember the information so that I recall it when I see the patient next time.
Clearly action (1) is the most desirable and probably only suitable option from a clinical governance perspective – no audit trail with 2nd or 3rd and therefore no safety or security wrapped around it.
This may not work in psychiatry but we all need to work together to find solutions that support what we are all doing. It may well be that new policies and procedures need to be derived because the old do not fit the reality with the new ways of working. Do you remember there was once a time when a man had to walk in front of a train with a flag in his hand to warn others of what was behind him. If rules like that still existed then we would never have the high speed trains that we do today.
The key question is how do we reach a balance between what patients want and what clinicians feel they want or need. This is the role of the local Record Development Board and if it cannot be resolved there then the national Care Record Development Board. It is important that all stakeholders including clinicians and patients are made aware of this so tha we can all learn from each other.
I am pleased to see Dr Huda is taking a very active role in this and helping us all to understand some of the nuances better.
but Amir
the law already states that patients do not have a 100% access to their records, including in cases where it may lead to harm (emotional and physical) to somebody who gives information on the basis of 3rd party confidentiality
now this is ethically sound, we live in a society where there are often compromises in terms of rights so long as patients are aware there is confidential info held about them that should be sufficient
we should beware of creating infringements on other’s rights, such as carers, now the “post-it” solution is imperfect, you will neeed to create a system where all info is reviewed prior to putting on the online record
to remove 3rdparty confidential info, either not to be put on an online record at all (reducing its’ utility) or to put in a folder that the patient can not access
I understand the issue well but am questioning whether the law is right or not on behalf of my patients and the public at large in this NEW PARADIGM where letters can be seen instantly by patients as soon as they arrive within the practice. Presently there is no facility to hide information in a “sealed envelope” or “folder” as you describe preventing patients from seeing such info. The only way it can “hidden” is if it is not scanned in at all presently OR if you choose to write a letter in such a way that does not reveal the source of the 3rd party. There is a key question that we are now asking within the Records Access Collaborative that I would like to share with you throughout the world around “business back office process”
When letters come in from the hospital, we have 2 choices as a practice:
1) Letter is scanned in and THEN given to the doctors to look at and act upon it when they get some free time
2) The letters are seen first by the doctors and only THEN after they have checked for any 3rd party data are the letters then scanned in
The latter would be “within the law” except that we still don’t know what to do with letters that contain 3rd party data in them. We do not have a facility to “blacken out” any 3rd party data before it is scanned. If we blacked it out, we would not be able to see it either witihn the practice.
But whilst that letter is not scanned, it is not available for anyone else in the practice (or outside it) to see. Is that good enough from a clinical governance perspective? We often get letters asking us to change a medication or start a new treatment for someone because their clinical condition merits it. Delay in starting the medication may have serious consequences. We have to weigh up the benefits of enabling all to see all the information that is coming in to the practice against the harm that exposing 3rd party information may have. There are strong opinions on both sides of the fence. In terms of numbers (and I understand that the principle is more important than simply numbers) more patients and clinicians would benefit from patients seeing their letters etc immediately than those who may come to harm from seeing 3rd party info.
However this is a significant debate that is taking place and we do need to come to some form of resolution. We think that it may be up to individual practices to decide where the risk should lie rather than trying to find some form of legislation.
One of the key points you have raised about 3rd party data is that the identity of the individual giving the information is compromised. Would it not be possible to simple say that such info was given without exposing the identity of who gave it? That would reduce the risk further although not completely eliminate it. If it would be obvious that there could only be one person (eg spouse) who had supplied that sort of info then you may even decide in the best interests of the spouse that their right to confidentiality may be greater than my need to know the source of the info or even the info itself. You may want to make a note at the bottom to say that 3rd party info was used to make a judgement on the patient’s clinical condition if you felt this was justfied. Ultimately as a clinician you would have to back up your management plan and what you chose to do and why to your peers. A letter would be supportive evidence but not the only evidence.
I am certain that this problem can be resolved by discussion between primary care clinician, secondary care clinician, patient and the 3rd party info giver. I think the IT is likely to complicate issues and open to risk of it going wrong. This will become even more important as more and more information becomes more openly available for others to see.
If there is third party information being sent could the sender not mark it as such on the top of the page, say the left top corner? When the letter arrives at the surgery it would be easily seen and put to one side for the doctor to read. This way letters not ‘flagged’ could be safely put on to patients records.
Hi Zippy
Good idea but what do we do with the letters that CONTAIN 3rd party data? Sure the clinician sees them but then what. If they are not scanned in then they are not available for anybody to see – clinician or patient.
I note your comments Amir but am a bit worried, essentially you are saying the goal of “100% immediate total access to records” largely over rides other considerations a worrying variant of “the ends justifies the means” however statue and ethics both agree this is not the case you can question this (on behalf of patients etc) but you can not unilaterally decide to ignore the law because you think you are serving a greater good.
you have no evidence that the goal of 100% access will lead to better clinical outcomes than the potential harm caused by ignoring 3rd party confidentiality apart from “guesstimation”
ypu suggest we do not send info to you that may cause you to illegally scan it into the online record for patients to access in order to avoid the delay of it being screened initially.
is the consequences of delay going to be so great that it can’t wait to be screened by the GP?
In fact are we pointing out a significant resource issue that this info is going to need to be screened involiving time and money for this process?
the alternative is to send only “safe” info to this online system, a great shame really as this implies a second class system. The online system has the potential to cause a “revolution in medical affairs”, with info being available to clinicians and patients at the “point of treatment”. Unfortunately if we adopt this “second class” system only able to accept “safe” (legally, clinically) info then this goal will not be achieved. Clinicians may be forced to acces “safe” systems to store their info and lead to a fragmented, divisive information system.
We know that in mental (and other fields of) health a major cause of serious adverse outcomes is the plurality of sources of information that are not gathered together leading to faulty clinical decisions- and that is not “guesstimation”.
Lets get the online record right. Beware of elevating laudable aspirations over other’s rights . Beware of creating a system that meets one goal over others and so becomes at best a grossly inadequate standard or at worst failing to provide a “single point of entry” to get all the inoformation a clinician needs about their patient.
some great things happening here. look forward to seeing this is practice. will this, or could this system include information to inform GPs of children on the child protection register or child assessment support system. as a student health visitor i have already come across children on the register who have seen the GP, but the GP was unaware of the situation. im sure this will have confidentiality problems. also who will have access to childrens records. what age is deemed as responsible for your own
Too many services in internet called Ask a Doctor simply have no license for the activity who it supervises and how with these to struggle? WBR LeoP