Background Partial patient online access to medical records is already offered by most general practices in England. Maximising the acceptability of this online service is strategically important to NHS England as it offers the potential for improving patient satisfaction and enhancing shared doctor-patient relationships. However, there is little evidence about the unintended consequences associated with providing this online service to patients.
Offering patients direct access to their online medical records will put patients in more control of their online medical records, which has the potential to increase service efficiency, doctor-patient communication, patient self-care, whilst potentially reducing patient anxiety and improving patient satisfaction. However, there remains a lack of empirical evidence from primary care in England and thus there a degree of uncertainty around what benefits might actually be bestowed by providing online access to medical records.
There is even less evidence about the potential harms associated with online medical records or the procedures for mitigating their impact on at-risk patients. Some health professionals have voiced their unease about patient anxiety or confusion resulting from online medical records access, whilst others have considered the impact of inappropriate information on doctor-patient relationships. However, the most concerning potential harm is that of coercion and how it might be used to undermine the privacy and confidentiality of an individual’s online medical records. Coercion can appear as someone trying to support a vulnerable relative, such as a child, elderly individual or someone with learning disabilities. Or, alternatively, it may manifest as overt threats of punishment or physical abuse, especially for those individuals experiencing domestic violence or abuse (DVA).
The proposed research would investigate the complexities of providing general practice patients with access to their online medical records, identify the unintended consequences associated with this online service and develop evidence-based guidance for service providers in the future.
Aims The aims of the research are: (i) to identify the range of unintended consequences associated with providing access to online medical records to general practice patients in England; (ii) establish the different approaches currently being used in general practice to avoid introducing unintended consequences; (iii) to develop guidance for healthcare professional to help reduce unintended consequences in the future.
Plan of Investigation In order to meet these aims the research will consist of three Phases: • In Phase I a systematic literature review will be used to identify the types of unintended consequences associated with online medical records services and the types of patients that may be affected.
• In Phase II qualitative interviews will be conducted with general practice staff to identify the types of approaches being used to reduce or manage unintended consequences associated with online medical records. This information will be gleaned from a sample of general practitioners, practice nurses, practice managers, IT specialists and receptionists (and other relevant staff as required). Qualitative interviews will also be conducted with general practice patients to ascertain their views about the appropriateness of these methods.
• Phase III will use evidence collected from the aforementioned work to inform general practice guidelines for reducing the unintended consequences associated with providing patient access to online medical records.
This research will contribute significantly to the currently limited evidence base on how to identify and mitigate the unintended consequences associated with patient electronic access to their medical records. This work will allow policy makers and the NHS, including the many practices currently not offering online access to medical records, to consider how best to implement this service.