Implications of the changes to patient online records access in English primary care

McMillan, Brian; Davidge, Gail; Blease, Charlotte; Watson, Jessica

doi:10.3399/bjgp22x721205

Cited by 6 publications

(3 citation statements)

References 9 publications

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“…This is unlikely to surprise practising clinicians, but has important implications given the move to offer all patients in England access to their blood test results via the NHS App. 22 …”

Section: Discussionmentioning

confidence: 99%

“…This is unlikely to surprise practicing clinicians, but has important implications given the move to offer all patients in England with access to their blood test results via the NHS App. 20 Further research to explore how patients interpret these borderline results is needed; although a clinician might mark these as 'satisfactory' or 'normal', if patients see that their test results are outside the reference range it could potentially trigger alarm. This is backed up by data from the US; after implementation of online records access one medical centre measured a doubling in the number of messages sent by patients within the 6 hours after patients reviewed a result.…”

Section: Implications For Research and Clinical Practicementioning

confidence: 99%

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Exploration of reasons for primary care testing (the Why Test study): a UK-wide audit using the Primary care Academic CollaboraTive

et al. 2023

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Background: Rates of blood testing have increased over the past two decades. Reasons for testing cannot easily be extracted from electronic health record databases. Aim: To explore who requests blood tests and why, and what the outcomes of testing are in UK primary care. Design and Setting: Retrospective audit of electronic health records in general practices in England, Wales, Scotland, and Northern Ireland. Method: Fifty-seven clinicians from the Primary Care Academic CollaboraTive (PACT) each reviewed the electronic health records of fifty patients who had blood tests in April 2021. Anonymised data were extracted including patient characteristics, who requested the tests, reasons for testing, test results, and outcomes of testing. Results: Data was collected from 2,572 patients across 57 GP practices. The commonest reasons for testing in primary care were investigation of symptoms (43.2%), monitoring of existing disease (30.1%), monitoring of existing medications (10.1%), and follow up of previous abnormalities (6.8%); patient requested testing was rare in this study (1.5%). Abnormal and borderline results were common, with 26.6% of patients having completely normal test results. Around a quarter of tests were thought to be partially or fully unnecessary when reviewed retrospectively by a clinical colleague. Overall, 6.2% of tests in primary care led to a new diagnosis or confirmation of a diagnosis. Conclusion: The utilisation of a national collaborative model (PACT) has enabled a unique exploration of the rationale and outcomes of blood testing in primary care, highlighting areas for future research and optimisation.

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“…This is unlikely to surprise practising clinicians, but has important implications given the move to offer all patients in England access to their blood test results via the NHS App. 22 …”

Section: Discussionmentioning

confidence: 99%

Section: Implications For Research and Clinical Practicementioning

confidence: 99%

Exploration of reasons for primary care testing (the Why Test study): a UK-wide audit using the Primary care Academic CollaboraTive

et al. 2023

Self Cite

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“…The United States, Canada, and Scandinavian countries, particularly Estonia, Sweden, and Norway, have been at the forefront, providing access to a significant number of patients across multiple regions [ 2 , 3 ]. More recently, the United Kingdom introduced the NHS app, offering access to primary care provider medical records since just last year [ 4 ]. In Germany, offering ORA was made mandatory for statutory health insurance providers by 2021, although the inclusion of open notes remains uncertain [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Reasons for Acceptance or Rejection of Online Record Access Among Patients Affected by a Severe Mental Illness: Mixed Methods Study

Schwarz,

Meier-Diedrich,

Neumann

et al. 2024

JMIR Ment Health

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Background Over the past few years, online record access (ORA) has been established through secure patient portals in various countries, allowing patients to access their health data, including clinical notes (“open notes”). Previous research indicates that ORA in mental health, particularly among patients with severe mental illness (SMI), has been rarely offered. Little is known about the expectations and motivations of patients with SMI when reading what their clinicians share via ORA. Objective The aim of this study is to explore the reasons why patients with SMI consider or reject ORA and whether sociodemographic characteristics may influence patient decisions. Methods ORA was offered to randomly selected patients at 3 university outpatient clinics in Brandenburg, Germany, which exclusively treat patients with SMI. Within the framework of a mixed methods evaluation, qualitative interviews were conducted with patients who chose to participate in ORA and those who declined, aiming to explore the underlying reasons for their decisions. The interviews were transcribed and analyzed using thematic analysis. Sociodemographic characteristics of patients were examined using descriptive statistics to identify predictors of acceptance or rejection of ORA. Results Out of 103 included patients, 58% (n=60) wished to read their clinical notes. The reasons varied, ranging from a desire to engage more actively in their treatment to critically monitoring it and using the accessible data for third-party purposes. Conversely, 42% (n=43) chose not to use ORA, voicing concerns about possibly harming the trustful relationship with their clinicians as well as potential personal distress or uncertainty arising from reading the notes. Practical barriers such as a lack of digital literacy or suspected difficult-to-understand medical language were also named as contributing factors. Correlation analysis revealed that the majority of patients with depressive disorder desired to read the clinical notes (P<.001), while individuals with psychotic disorders showed a higher tendency to decline ORA (P<.05). No significant group differences were observed for other patient groups or characteristics. Conclusions The adoption of ORA is influenced by a wide range of motivational factors, while patients also present a similar variety of reasons for declining its use. The results emphasize the urgent need for knowledge and patient education regarding factors that may hinder the decision to use ORA, including its practical usage, its application possibilities, and concerns related to data privacy. Further research is needed to explore approaches for adequately preparing individuals with SMI to transition from their inherent interest to active engagement with ORA. Trial Registration German Clinical Trial Register DRKS00030188; https://drks.de/search/en/trial/DRKS00030188

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Patient safety in actioning and communicating blood test results in primary care: a UK wide audit using the Primary care Academic CollaboraTive (PACT)

Watson,

Duncan,

Burrell

et al. 2024

BMJ Open Qual

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BackgroundErrors associated with failures in filing, actioning and communicating blood test results can lead to delayed and missed diagnoses and patient harm. This study aimed to audit how blood tests in primary care are filed, actioned and communicated in primary care, to identify areas for patient safety improvements.MethodsUK primary care clinicians were recruited through the Primary Care Academic CollaboraTive (PACT). PACT members audited 50 recent sets of blood tests from their practice and retrospectively extracted data on blood test result coding, actioning and communication. PACT members received a practice report, showing their own results, benchmarked against other participating practices.ResultsPACT members from 57 general practices across all four UK nations collected data on 2572 patients who had blood tests in April 2021. In 89.9% (n=2311) they agreed with the initial clinician’s actioning of blood tests; 10.1% disagreed, either partially (7.1%) or fully (3.0%).In 44% of patients (n=1132) an action (eg, ‘make an appointment’) was specified by the filing clinician. This action was carried out in 89.7% (n=1015/1132) of cases; in 6.8% (n=77) the action was not carried out, in 3.5% (n=40) it was unclear. In the 117 cases where the test result had not been actioned 38% (n=45) were felt to be at low risk of harm, 1.7% (n=2) were at high risk of harm, 0.85% (n=1) came to harm.Overall, in 47% (n=1210) of patients there was no evidence in the electronic health records that results had been communicated. Out of 1176 patients with one or more abnormal results there was no evidence of test communication in 30.6% (n=360). There were large variations between practices in rates of actioning and communicating tests.ConclusionThis research demonstrates variation in the way blood test results are actioned and communicated, with important patient safety implications.

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Implications of the changes to patient online records access in English primary care

Cited by 6 publications

References 9 publications

Exploration of reasons for primary care testing (the Why Test study): a UK-wide audit using the Primary care Academic CollaboraTive

Exploration of reasons for primary care testing (the Why Test study): a UK-wide audit using the Primary care Academic CollaboraTive

Reasons for Acceptance or Rejection of Online Record Access Among Patients Affected by a Severe Mental Illness: Mixed Methods Study

Patient safety in actioning and communicating blood test results in primary care: a UK wide audit using the Primary care Academic CollaboraTive (PACT)

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