1. Patient online access to records An overview of the barriers Paul Fleming Head of IT, Stockport PCT NIGB Presentation April 2012

2. Health Informatics MSc UCLAN Studied 4 practices in Stockport, Tameside & Glossop during 2011. On site semi structured interviews Practice Manager, GP and member of admin team Quantitative data from supplier Literature review with international scope The Research

3. Emis Access usage 2004 - Repeat medications and appointment booking 2007 - Patient records access 1% Practices use RA Pockets of pioneering practices Other suppliers developing patient access systems including hospitals.

4. Characteristics of users 40-65 year oldsHigher educated The acutely unwellWomen Young IT literateContinuing diseases Young elderly, recently retiredAffluent Just noseyWorkers Parents with younger childrenHigh users of GP services

5. More than 90% felt that records access benefits patients Managing chronic illness/long term conditions Convenience – saving the patient time and in some cases money Being informed about your own health and increasing understanding Patient control, responsibility and ownership Breaking the mould of “the GP tells you” Sharing information Findings : Benefits for patients

6. Access rate of medical record views, per signed up patient

7. Culture Education Technology Barriers to use and adoption

8. Concerns about security Patient more worried after accessing record Small number of patients less confident in GP after accessing technical issues both providers and consumers of care must develop different mind sets when trusting each other with information Confidentiality concerns Security concerns lack of focus on the patient’s needs and expectations (Healthspace) Resistance to change Visual impairment Would imply a lack of confidence in GP The ‘unknown’ aspect from the patient perspective lack of financial incentive for providers paternalistic health care system could threaten the control and authority of the current record holders, the providers of care Other barriers to adoption

9. Patients understanding of what they find Patients might not be happy with what they find Medico-Legal risks Third party data Human errors leading to security risks. The Risks

10.  Culture  No clear strategy (or funding) for implementation  Not currently incentivised  Functionality is inconsistent across suppliers  High level, national standards not yet established  Being scared of the unknown (patients and care providers)  Lack of awareness Overarching barriers

11. Robust policy, procedure and standards minimises risk Train staff properly and routinely, educate patients Have a GP Champion within each practice. Involve clinicians and patients at the planning stage Use multiple methods of promotion (5 or more for best results) Screen important results first Assess patient first (especially around mental health problems) Recommendations

12. Explore more centralised support functions for password resets and assistance. Publish standards for suppliers to ensure safe, robust and available systems Joined up approach for the future between Primary Care, Community, Acute and Local Authority Recommendations cont.

13. Questions Contact: paulfleming@nhs.net 0161 426 5629paulfleming@nhs.net

14. Trends in Internet Access 73% of households connected to the Internet. Changing consumer behaviours retail, banking, tourism. Increase in Internet use on smart phones. Tablets Faster, easier, cheaper

15. Awareness levels of records access service are high within early adopter practices. Cultures and attitudes are positive around records access within the sample practices. Patients accessing their own records can potentially reduce administration workload within the practice setting. There are resource overheads with implementing and providing support for online records access. Conclusions

16. Having a GP clinical champion leading records access increases the rate of views of online records. There are a number of risks and benefits to records access. Risks can be mitigated by implementation of robust policy and processes. Patients at early adopter practices are positive about records access and come from different backgrounds and age groups. Training and education around records access within early adopter practices is not delivered formally and is adhoc in nature. Further work is required to address technical issues with the current systems of records access. Conclusions cont.

17. 11 out of 12 felt records access benefitted practice Saves time, cuts workload Gives patients a better quality of service, an added service Benefits to the Practice

18. Clinician contacts Posters, leaflets Patient Participation Groups SMS Text Web site promotion Newsletter, email shots Patient display boards and TV screens Phone messages Promoting access to patients

19. Identify promotional strategies that have the potential to increase uptake and continual online access of medical records for patients. Identify and explore the perceived barriers and benefits of patients accessing their records online from the practice perspective. Identify attitudes towards patient online access to records from the perspective of different roles within general practice. Aims of the research