Enhanced Patient Access – the challenges and benefits
Enhanced patient access is part of the NHS long-term plan, all of which aims to serve the UK population with a better, more efficient, and more effective healthcare system.
What is happening in the NHS is in line with similar developments around the world. And is a response to a mix of common social, economic, and political pressures.
- Give patients the information to act on
- The core issues and considerations for primary care practices
- Enhanced Patient Access is nearly fully live.
- Why have enhanced patient access?
- What will the patient be able to access?
- What are the positives of enhanced patient access?
- What are the negatives of, or concerns about, enhanced patient access?
- How Lexacom can help
Enhanced patient access is grounded on the belief that by giving patients better access to their health records, they will have a better understanding of their own health situation. Then in partnership with their health care system, better manage their own health.
Thereby relieving some of the pressure on the healthcare system, enabling it to serve a growing and aging population without a related increase in resources. That is the established ‘doing more with the same’, management strategy.
Smartphones, the internet, and related technologies now enable this capability to be delivered in a simple to access manner. In the UK that is via the NHS app as well as the related online account.
While this is the concept, enhanced patient access has thrown up a range of issues and considerations for primary care practices, both on the clinical and admin side of operations.
For example, the need to make the patients’ records easy to understand means the use of plain English, less jargon, and more explanation. All of which add to the GP’s daily workload.
Additionally, surveys have shown that patient contact with their practice can go up, rather than down, as they seek clarification of the notes they can now read. Again, adding to the time burden placed on the practice. Plus, serious issues of safeguarding have been flagged, both for under 16s and vulnerable adults.
In this article, we look at the organisation, positives, negatives, and unintended consequences on primary care practices, of enhanced patient access.
We then end the piece with a brief exploration of how Lexacom’s products and services can help.
Enhanced patient access was planned to go live everywhere in October 2021 but was delayed until April 2022 due to concerns raised by the BMA and others.
That revised deadline passed, and the expectation is now that the development will be live in November 2022, on the TPP and EMIS systems with those on Vision going live later. Of course, many practices are ahead of this schedule, and their patients already have access.
The delay has been over a range of issues, including safeguarding, and the consequent need for staff training and awareness.
As outlined in an NHS England statement in April: “NHS England appreciated that further time was needed to prepare systems and staff for the changes and to provide training on ensuring sensitive information is safely hidden from patient view as it’s entered on systems”.
Patients’ ability to access their own medical records has been a key part of creating a more patient-centered NHS.
This is not just a UK goal, but a shared one across most developed countries.
It is driven by studies that show increasing patient access to their medical records enhances doctor-patient communications, reduces errors, and improves patient health.
This leads to cost savings and the ability to focus resources on more critical areas. All of which is appealing when faced with a population that is growing in numbers and living longer.
Plus, research indicates that patients want this to happen, with 80% of the 26 million NHS app users saying yes to having access to their health information.
Also, the technology to enable and support this is now widespread. With patients having access to the internet, the use of smartphones and apps, and the existence of a digital culture in the broad population.
So, it could be said that enhanced patient access is an idea whose time has come.
While access to all their medical and health records is the ultimate expression of enhanced patient access, to start with it will be more limited in scope.
When live, patients using the NHS app or an online account will have access to their future, or prospective, full GP health record including free-text notes, letters, and other documents. That is new entries will be available, but not past ones unless they have already been given access to it by their GP practice.
Additionally, patients will not have sight of communications on administrative tasks about them between practice staff.
Importantly, patients will not see information such as test results, until they’ve been processed, and clinicians have contacted patients to discuss their results
As discussed below, Practices will also have a level of customisation of what can and can’t be seen. And the ability to remove access, if this is deemed appropriate, on a case-by-case basis
Of course, all this means that the Practice teams will have to change their approach to patient records.
GPs and clinicians, for example, will need to consider how each entry might be read by the patient. Both from an understanding of what is said and an appreciation of how the patient may react.
There have been several surveys on the Norwegian and American equivalents of enhanced patient access. These have highlighted these positives for patients and clinicians/practices:
Better patient health management
The overall finding is that better access helps patients manage their health better and reduces queries to Practice on items such as test results and referral letters.
Increased patient engagement
Most patients using the systems say they feel more in control, have a better understanding of the what’s and why’s of their treatments and referrals, and crucially, are better at actioning treatment plans and taking medications.
Improved understanding and insight
Most clinicians surveyed see the programme, as being a good step. One which provides an effective follow-up to actual practice visits, as it gives patients more time to read and reflect on recommendations and notes, away from the time pressures of the visit.
Improved trust in clinicians
The change in the language used in the patients’ notes, to make things clearer and easier to understand, helped improve patient recall, actions, and trust in the treatments they’d been prescribed.
Additionally, where supportive, positive, and empathic wording had been used, patients were even more positive. Which is a factor in beneficial health outcomes and patient satisfaction.
While the US and Norwegian surveys found the above positives, they also found a wide range of negatives and concerns:
Patient confusion and concern
Some patients became unnecessarily concerned or confused by what they saw in their notes. This led to increased calls to the practice, as the patients’ sought answers to their queries.
As an opposite, a GP detailed that a patient no longer wanted online access because they did not want to read about their growing medical problems.
Clinicians spend more time writing notes
Nearly half of the surveyed clinicians reported that they now spent more time writing notes than they had done before. As they had become more conscious of spelling mistakes, and their use of jargon and abbreviations, all of which raised their concerns about their patient’s understanding of their notes.
Clinical notes change and become less useful
A concern was highlighted that clinicians would change the nature of their note-taking, knowing that a patient can view them. This has the potential to make the notes less useful for follow-up actions, diagnosis, and historical review.
In Norway, the survey found that some clinicians kept shadow records as they felt the patient should not see certain information. Such a workaround has obvious potential for patient risk and safety, plus data security problems.
Redactions add to practice workload
The preparation of records before giving patients access added to practice staff workloads. This was primarily caused by the need to check for, and act on, any redactions for references to third parties, and “information that could lead to a risk of harm”.
Vulnerable patients need supporting
In several cases, GPs took proactive action to discuss with vulnerable patients what they would see in their records, how the GP could help, and to provide them with other avenues of support.
One of the surveys noted a case of a patient who’d had a long history of abuse. The GP’s concern was that by being able to see their own records the patient could be mentally and emotionally harmed.
The additional workload was necessary for managing access to the records of teenagers, where safeguarding was a concern. This worked both ways with parents not wanting certain comments to be seen by their children and vice-versa for children. This issue became more complex in the case of separated or divorced parents.
The increased workload here was caused by both the management of the records and having to sensitively navigate the related conversations with the parents and teenagers.
Safeguarding victims of abuse
Practice staff detailed how they needed to manage elements of records patients could access in cases of domestic violence and abuse. Their concern being that full access could cause harm if perpetrators viewed their partner’s records.
To achieve this management required case by case actions, with preferably face-to-face discussions with the patient, alone/away from their abuser, to discuss what should be available. A tiered approach to levels of what could be accessed was deemed unsuitable, and only a tailored individual approach was best.
Note: In response to such concerns, the Royal College of General Practitioners is updating its patient online toolkit, in collaboration with safeguarding experts.
Increased time to manage records
An additional level of workload came from managing and maintaining records, once patients raised queries, challenged information, and highlighted errors. Error-correcting was an additional but simple task. Whereas dealing with patient challenges led to time being taken up with discussions that would not have occurred prior to patient access.
Specialisms become an additional challenge
The specialists that GPs refer patients to will also add to the patient record. Here things step up a level as the professional vocabulary used becomes even more niche. For example, ophthalmologists use a lexicon of abbreviations and professional terms that can be difficult for non-ophthalmologist clinicians to understand, let alone patients
To counter this, training on how to communicate the details of their work, in an easy-to-understand manner, is required, and probably hasn’t been highlighted as a need in the rollout plans for enhanced patient access.
With a heritage of serving the NHS that goes back over twenty years, Lexacom has a range of products and services that support the implementation of enhanced patient access.
Each of our products saves the user time. Freeing them up to either do other tasks or do more of a task, such as note-taking, in the same amount of time.
Lexacom Echo – save time taking notes
Our speech recognition software supports contemporaneous note-taking, with its medical-specific dictionary, and capability to save users up to 80% of the time they spend typing.
Lexacom Scribe – save time on transcriptions
Our outsourced transcription service, with next-day delivery and use it as you need it, subscription model. By using Lexacom Scribe, the practice staff’s time can be used on other tasks, such as those that support enhanced patient access.