The Pharmaceutical Journal
Vol 278 No 7438 p160
10 February 2007

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Patients hold the key to who may have access to their medical records

A pilot service giving patients password-protected internet access to their medical records might help pharmacists too. Clare Bellingham reports

Ask a group of community pharmacists what would make their professional lives easier and many would say access to patients’ medical records. But this is something that has, so far, eluded the profession.

Now a pilot service, which allows patients to access their own medical records via the internet, could solve the problem. One of the doctors at the centre of the pilot — which will be rolled out to 100 sites in the next few weeks — says patients can use the technology to give pharmacists access to their records.

Amir Hannan is a GP at Thornley House Medical Centre in Hyde, Cheshire, and the lead for both IT and clinical governance at Tameside and Glossop Primary Care Trust. He explains: “It is a bit like internet banking, and involves patients using passwords to access the information in their medical records.”

It is because patients hold the key to access that Dr Hannan thinks the system could prove useful for pharmacists. “I have met area representatives for both Boots and United Co-op Pharmacy in Tameside and talked to them about how this could be used in pharmacies,” he says. Providing pharmacies have the internet available on a computer in a private consultation area then patients can use this computer to access their records. “I think it would be better for pharmacists to turn away from the computer screen and get the patient to enter their own password, rather than asking the patient what their password is. That way, there is no issue about confidentiality: it is the patient who decides which pharmacist to give access to and when this access is given,” says Dr Hannan.

How the pilot works

The software that enables this web access is provided by GP system supplier Emis Healthcare. “Patients have two passwords. The first password allows them to book appointments and order repeat prescriptions online,” says Dr Hannan. “Then, at the next level, putting in the second password means the patient can access their full medical record.”

Sean Riddell, managing director of Emis Healthcare, says that about 1,000 practices already offer online appointment booking and prescription ordering. So far, seven practices — of which Dr Hannan’s is one — are piloting the web access to records. “We are taking this one step at a time so we can see the benefits and drawbacks to patient care of having access to records,” Mr Riddell says.

At the first password level, the only patient information displayed is a list of the patient’s repeat medication. After the second password is entered, an initial summary of information is displayed including significant medical history, allergies, repeat medicines, family history and recent test results. Clicking on various links allows the patient to see more detailed information.

“Nothing is held back,” says Dr Hannan. “Everything that is entered on the computer in the practice is available for the patient to see. That includes all consultation notes, test results and letters. If a pharmacist writes a letter to the surgery about a patient, that will be scanned in and attached to the record. If I write a referral letter to a consultant, that will be scanned in and attached.”

This complete access has caused some concerns. “If test results arrive electronically then patients can see them before the doctor has been able to interpret and explain them. Different doctors have different views about this,” says Mr Riddell. “The next stage in the pilot is to develop a quarantine area on the patient record where information like this comes in before it is added to the web-accessible record.” Emis will be recruiting 100 GP practices from across the UK to this next stage of the pilot within the next few weeks. “The key premise is finding out if health care is benefited by allowing web access to records. So far, it is going very well,” he comments.

Dr Hannan is clear that the service provides many benefits. “It improves the quality of consultations and it makes patients feel in control,” he says. In terms of practical uses, he cites examples of patients arriving at hospital appointments when the hospital has not received the patients’ notes. Instead of a wasted appointment, patients are able to provide the access needed via the internet. He also speculates that a pharmacist given access by a patient could have intervened in a recent case in which a patient was prescribed amoxicillin by an out-of-hours doctor when she is allergic to penicillin. “It is about making the system safer for patients,” he says.

What do pharmacists think?

Pharmacist Raj Modi, who represents the local pharmaceutical committee on Tameside and Glossop PCT’s IT strategy group, has seen the service working at Dr Hannan’s surgery. He sees potential benefits for pharmacists if patients provide them with access.

“It can enhance the pharmacist’s role. For example, when you see a patient who is taking a drug which has seven or eight uses and the patient asks what it is for, rather than speculate, you can use the patient’s record to provide specific information,” Mr Modi says. “Another benefit is in conducting medicines use reviews. If you can look at the patient’s record then it can help answer questions, or makes you better informed when speaking to the doctor.”

Although this service is not part of NHS Connecting for Health’s summary care record, Dr Hannan sees no reason why patients cannot use both. “The CfH record will provide the basic information but patients can also opt in to access their full medical records. The important message is that patients will hold the key to whom they give full access to,” he comments.