Real-time Digital Medicine and the Partnership of Trust

Real-time Digital Medicine and the Partnership of Trust

On 15th March 2020, the British Islamic Medical Association invited Dr Hannan to talk about why the practice started to offer patients full records access and understanding including free text from when the electronic health records began (October 2000 for patients registered with the practice) as part of enabling a knowledge-driven healthcare system. 

This followed from the Partnership of Trust – a relationship formed between patient and clinician when the electronic health record is shared between patient and clinician and a better understanding is forged between them. 

The explicit consent process developed in 2004, shared with many different organisations and stakeholders and  maintained to this day requires all patients or their carers to complete a Records Access and Understanding Safety Checklist questionnaire. This is processed by the staff who also check the electronic health records before granting the patient the full access to the records and adding the code “Patient remote record access enabled” to the Significant Active problems list. This allows us to know when we see the patient that they have full access to their electronic health records and because it is coded data, we can also do searches for different types of patients which allows us to publish this table very week and show what is happening across our patient population.  We build trust by ensuring the patients see the whole GP electronic health record and not just a subset unless there is a good reason not to. 

Whilst there are a wide number of apps available that patients can choose, we invite patients to choose either Evergreen Life PHR or Patient Access. This is because patients will get the best experience from these apps and our staff are trained to help deal with most queries. Whilst both apps offer the ability to view the electronic health records as well as order prescriptions online, there are differences between them which our staff are able to inform them about. 

The Evergreen Life PHR app is a health and wellness app as well as providing access to GP online services. It gives patients the opportunity to monitor their happiness levels, fitness and food as well as providing notifications for when it is time to take their medication and make notes about their condition as well. They can also see all their test results easily on one screen with the results next to each other.

The Patient Access app in some ways is simpler to use because it offers the GP Online services. It does however allow carers to view the records via a single email address and password without the need to remeber other passwords. It also allows the patient to see individual test results so that you can see graphs showing how the test result changes over time.

We advise patients to use both apps because they do complement one another and ultimately over time, you will decide what is best for you. You can learn more about the similarities and differences here

The practice-based web portal was designed from the ground up to support the partnership of trust and to help patients and their carers to get a better understanding of their healthcare needs by knowing what the practice is doing and also what is available locally. 

The website is not designed as a “stand alone” but rather to support and enhance what happens in the consulting room. Patients are often directed to specific webpages during the consultation rather than expected to search for things themselves. Consultations include references to specific webpages that patients can navigate to at any time in the future and referred back to relevant information that they can read up or watch at a later date. By keeping the webpages and links up to date, they are continually kept up to date with the latest infromation without needing to be constantly reminded of this.

By giving all patients the opportunity to have full access to their GP electronic health records, understand their health and healthcare better, have the opportunity to correct any errors or omissions in the record, we also believe they can also give their informed consent when ask if their records can be viewed by others eg in A&E or for other services. We call this Responsible Sharing. This does not mean that the patient must be able to view their own records before allowing others to view them – simply that they should be actively supported and encouraged to do so as it is in their best interests to do so. Click here to learn more about Responsible Sharing

You can see the latest data showing how many patients have signed up for full access to the GP electronic health records here. All patients are encourged to use all the other online services as well once they have signed up. We continually monitor what patients feel about the services and try to ensure we leave nobody out. Much of the behaviour change necessary happens in the consulting room when patients speak to the doctor or nurse and are invited to sign up by completing the safety checklist questionanire and any questions about this are answered. This makes a lot of sense because as part of shared decision-making, when the clincian is agreeing to refer the patient, arranging a blood test, starting a new medication or advising them about what to do, it is an ideal oppiortunity to inform the patient that they do not need to try to remember everything because they can just as easily sign up, log into their electronic health record, read it for themselves and then share this with others whom they think may need to know too eg family or perhaps if they fall ill, are planing to travellign abroad or even going to the hospital. Patients often come with their carers who are invited to sing up with the patient’s full consent too. It naturallty makes sense to do this when togeher. This partly explains why so many different groups of people have registered online as well where one would not expect them to be left behind. 

Learn how we are engaging patients (and staff) through the use of technologyThese technologies have really helped the practice to support patient care during the Covid19 pandemic crisis and helped to prevent further anxiety. Now that we are moving towards “normal working”, we hope to further develop the resources we have whilst enabling patients to get on with their lives.  

On the 1st October 2020, the First 5 GPs in Tameside & Glossop CCG asked me to do a presentation around my experience of Remote Consulting based on the experiences we have had of doing this over the last 4 years. As a result of the covid19 crisis, General Practice has changed for everybody and there is a new norm with many people being managed over the phone or via video consultations. This brings new opportunities as well as risks too. At the same time, expectations are changing for many people as more of us go online and can engage with their GP practices in new ways that were not possible before. This talk really explains what we have done having promised what we were going to do in March 2020 and what has happene and the questions raised by GPs newly qualified wanting to know more and how to do this. 

Click here to see a PDF of the presentation done (although we advise you to watch the talk to understand better some of the issues raised).

Are there any disadvantages to the vast majority of patients having full access to their records and consulting via AccuRx?

Because patients have to sign up themselves, it is their choice and hence they benefit or lose as a result of this. Of course it is not just sign up but also to use it. That’s why the focus changes from not just signing people up but helping people to use it too for their own advantage. Of course there are risks – what about those who are not online – are we widening the digital divide? 

Recently I spoke to a cousin of an Asian patient who has been here for almost a year and cannot speak English. The Asian lady said she was happy for her cousin to access her records for her. So her cousin asked me “so are all other practices also offering online services like we are ?”. I turned round and said “Do you know any Asian patient who phones their family back in Bangladesh and does not use whatsapp or skype? In this country even if you are on benefits, you have to go online to do this. I always said 16 years ago everybody is going to have to go online. It is just the way the world works now”. The same logic applies to all groups of people whatever their background.

All practices should offer online services, it is up to individuals who decide whether it is right for them or not. Of course, this brings its own challenges around what happens if there is a secret in that Asian patient’s record that she does not want her cousin to know about. This is where our skills as a GP are so important and why I believe the need for a “family doctor” who knows you and your family is even more greater. So yes there are risks but for the vast majority of patients the benefits far outweigh the risks. I wrote this piece for patients to understand issues around confidentiality, privacy, security and consent which you may also find interesting. I have not needed to share this link with anybody for years because for the vast majority – they just get it. Remember all those people who are going online now to do their shopping – why is that even though there is an increase in online fraud? Because convenience trumps all. I remain very vigilant though about the unintended consequences and searching for those who may come to harm and then think about how to support them. Here is a blog that you may also find interesting around domestic violence and access to GP electronic health records Electronic Health Records: There are many benefits but what about the risks? Both these links are part of our consent process and for people to read as they decide what is right for them. I am making the important information available for those who want to read it and know more. 

We have not had a single problem in 16 years (but that is not to say we will not and the potential is always there). The biggest challenge has been to get the wider healthcare system to understand why this is essential for General Practice and the wider NHS as well as the general public at a time when there simply is not enough money, doctors, nurses etc to do all the work and a patient workforce that is willing and ready and tech savvy to do this. The cousin laughed and went ahead and signed up as a proxy. I informed her it was imperative that she learns English so that she can one day do this herself. Our Patient Participation Group won an award for working with the local voluntary organisation to put on an “English as a Second Language” course which also signed people up for full records access and understanding. I had an interview in HSJ where I asked what about the patient and their needs too as well as our role in healthcare to help them get over any hurdles there may be. The new generation of doctors / clinicians / staff will want to work in a system that makes them feel good too and that they are making a difference. Remember I do not feel exhausted at the end of a full day’s work but rather invigorated and looking forwards to the next day. I work as a full on full-time GP and do all the other stuff too. So where do I get the energy from to do all this and how can others learn too?

Real-time Digital Medicine and the Partnership of Trust.

Dr Amir Hannan
October 2020