Blog: the implications of online access to patient medical records

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Dr Lisa Harrod-Rothwell, our Deputy CEO assess whether giving patients access to their records will deliver on the reasons behind doing it.

An impending deadline is generating much discussion and concern about the implications of online access to patient medical records, that is due to start from 1 November 2022. This was initially planned to commence in December 2021 but was delayed due to safeguarding concerns and the impact on patients and doctors. There were further delays because of these unresolved concerns and, with these still unaddressed, we wait on tenterhooks to see what will happen to this fourth go live date.

Before implementation, there have been calls for:

  • Greater transparency around the risks, with publication of NHS Digital clinical safety documentation and the lessons learned from earlier adopter sites, with published recommendations;
  • Support to practices to be able to implement this appropriately, with provision of robust training to all GP staff and support to establish appropriate processes;
  • Consideration of the impact on GP workload, in the context of the significant patient demand/workforce capacity mismatch that threatens all general practice services. Even in the unlikely best-case scenario, of the provision of adequate funded third-party redaction software provided to every GP practice, there would remain significant workload concerns and justifiable debate about whether this is how clinicians should prioritise their finite time.

These are very significant issues which aren’t even the biggest questions for me. The biggest questions are: What is it that we want to achieve? Is this the best way to achieve it?

I do not ask these questions because I have any objection to the principle of patients accessing their own medical records. However, for everything we do, the benefits have to outweigh the risks, and every NHS initiative must be clinically and cost effective.

It has been stated that medical record access will foster patient empowerment and involvement with their care, but the medical record is not written, nor fit, for this purpose. I write in medical language so that I, the clinician, can accurately convey to my colleagues, and my future self, the clinical details that I require to provide my patient with safe effective care. The medical record also provides me with evidence to be able to defend myself if my standard of care is ever questioned or in the event of complaint or claim, should that need occur; the careful documentation of the exclusion of all red flags, as advised by medical defence organisations, will not aid my patient’s engagement with their care.

To truly empower our patients through their medical information, we would have to invest resource and time in co-producing a meaningful patient facing record that is written and designed for this purpose. It would be wonderful to have the time in general practice to do this. Arguably, prioritising my time to write one such record a day would add greater value than routinely reviewing the day’s medical record entries and correspondence sent and received to ensure that data is coded and redacted appropriately.

As with many things in the NHS, we are embroiled in the ‘how?’ before the ‘why?’. There is a disconnect between the ideology of senior decision makers and how this can be achieved in reality and, once again, there is a belief that this can be achieved through a simple line in a contract with no consideration of the impacts, implications and safe implementation.

We await a satisfactory resolution.