Adapting to transparent medical records: international experience with “open notes”

Blease, Charlotte; McMillan, Brian; Salmi, Liz; Davidge, Gail; Delbanco, Thomas L.

doi:10.1136/bmj-2021-069861

Cited by 29 publications

(32 citation statements)

References 50 publications

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“…Findings highlighted concerns that ORA negatively impacted upon quality of record entries, patient safety, and workload (16). Combined, this research echoes findings from Sweden, the United States, and Ireland (17)(18)(19)(20)(21)(22)(23)(24).…”

Section: Introductionsupporting

confidence: 58%

Primary care staff’s views and experience of patients’ online access to their electronic health record: a qualitative exploration

et al. 2023

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Background: NHS England have announced plans to enable all adult patients to have full prospective access to their primary care record by default. Despite this, we know little about the views and experiences of primary care staff regarding patients accessing their records online (ORA). Aim: To examine the views and experiences of primary care staff regarding patients having online access to their primary care health record, and how this service could be supported and improved. Design and setting: A qualitative study of a purposive sample of 30 primary care staff in England. Method: Online semi-structured interviews with primary care staff were conducted between December 2021 and March 2022. Verbatim transcripts were analysed inductively using thematic analysis. Results: Most staff agreed with the principle of patient access to online health records but had mixed feelings regarding the potential benefits and drawbacks of applying this in practice. Staff identified opportunities for improving patient engagement, health literacy and efficiencies in some administrative workloads as well as concerns about maintaining the clinical integrity of patient records and ensuring that staff and patient safety and well-being are protected. Conclusion: Participants acknowledged that ORA may transform the purpose and function of the record and that ORA has potential to instigate a significant cultural shift in primary care, changing how staff work and relate to patients. This underlines the need for additional staff training and support to expand capability and capacity to adapt practice and enhance patient engagement with, and understanding of, their health records.

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Section: Introductionsupporting

confidence: 58%

Primary care staff’s views and experience of patients’ online access to their electronic health record: a qualitative exploration

et al. 2023

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“…Resources for clinicians and patients on how to adapt to a new world where electronic health records are a shared resource are available. 23 With access to care in the UK among the worst in Europe, 24 patients have little choice but to be more self-reliant. Ready online access to their full health record would help them and also reduce demand on the health system.…”

Section: Evidence Is Supportivementioning

confidence: 99%

“…Access to records and the opportunity to use them for interactive exchange22 could benefit most patients, particularly those with long term conditions. Resources for clinicians and patients on how to adapt to a new world where electronic health records are a shared resource are available 23…”

Section: Evidence Is Supportivementioning

confidence: 99%

Patient access to full general practice health records

Richards¹,

Coulter

McMillan

et al. 2022

BMJ

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Many countries empower patients to take on a larger role in their care by providing them with online access to their health records. 1 2 Transparent records, and patient access to them, are also key to improving the safety of care. 3 Approaches to sharing records differ internationally. Sweden rolled it out region by region from 2012.1 The US mandated it nationally from April 2021. 4 The UK government planned to do the same in England but its programme has foundered. 5 NHS England's programme to provide citizen access to general practice records was due to go live in December 2021, following a 2019 pledge to provide all patients with full digital access by default by 2020. 6 But launch was put back to April 2022 and then 1 November, after the Royal College of General Practitioners said practices needed more time and training to implement it. 7 In July, the college updated its online services toolkit and NHS England circulated guidance and resources for general practice staff based on the experience of 16 early adopter practices. 8 9

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“…What might doctors in the process of implementing transparent medical records learn from the US experience? Before the rollout of open notes, US clinicians expressed worries similar to those of doctors in England, who are at the start of opening up patient access to GP records 3. The experiences of US doctors provides reassurance in three areas: effects on workload, changes to documentation, and risk of litigation.…”

mentioning

confidence: 99%