Now is the time for all patients to have access to their medical record.
Dr Brian Fisher, a GP who had championed patient record access since the 1980s, had hoped as much would be achieved in 2007. But, despite local successes and the best efforts of ‘champions’ such as Dr Amir Hannan, who took over the Shipman practice with the aim of transparency and patient empowerment, the UK has dragged its feet with many still unable to access their records.
Covid-19, however, has accelerated changed behaviours in primary care. We have investigated the uptake of eConsult, a way of seeking consultations or advice from GPs, in Devon and Cornwall. In June 2019, there were just 6,239 such patient contacts. In June 2020, the figure was 52,277 – an 8-fold increase in 12 months.
But eConsult is ‘clunky’, asking questions for which the answers should be in the patient medical record. It has no continuity. You cannot say to it, “Doctor, you remember I consulted with you some months ago and you prescribed this? I don’t think it’s working well because...” It asks for any allergies and about smoking and drinking habits every time, even if you answered those questions a few days before. Aside from this, some of us would like to view our medical record simply to remember drug names.
GP contact (triage) systems like eConsult are ‘light touch’ members of a long and well-established line of research in computer-patient interviewing, started in 1966 by Professor Warner Slack. Computer-patient interviews have shown benefit in various specialties and been adopted widely in primary care systems in the USA since 2000.
Alongside the COVID-inspired increase in online consultations, patients have of course adopted the internet as a major source of information; one in five seek health information online weekly.
It has been clear for decades that patient record access, computer-patient interviewing, and patient information and education should be integrated; that patients should be empowered to put their online consultation into the context of their medical record; that they should seek information and clarification about their condition as they are asked questions. Thirty years ago, we reported our work aiming to bring these functions together using AI to create an integrated patient computer consultation. We continued (1996–2006) with rigorous research, including randomised trials in cancer and schizophrenia of patient record access where general information was tailored for patients using medical records, but these systems were never implemented in routine practice.
Dr Hannan has shown in one practice how to empower patients with access to their medical record. The pandemic has helped bring in widespread use of online contacts and consultations. International trends, such as the Open Notes movement, are helping to change attitudes and demonstrate the benefit of patient record access. Projects like the University of Plymouth’s EPIC, supporting small business in Cornwall to work with health and social care services and patient groups, can help bring patient record access to be linked to computer-patient interviews, apps, devices, and other eHealth developments.
The evidence is there. The capability has been available for long enough. Now really is the time for patient record access.
