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

Abstract

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.

Experiences and opinions of general practitioners with patient online record access: an online survey in England

“…Our survey supports recent qualitative research in England, which shows clinicians express partial ambivalence and scepticism about the impact of ORA on patients 25 26. Strikingly similar views have also been reported cross-culturally in countries where access is now more advanced.…”

“…Again, like previously published surveys in other countries, most of the English GPs we surveyed worried about access encroaching on their workload 25 26. This theme is also predominant in survey findings in other countries.…”

“…In addition, and although not determined in this survey, third-party access or how to protect vulnerable patients might also have been a safety concern for our respondents. Recent qualitative studies in England reported that primary care staff identified patient safeguarding, including for at-risk adults, such as those in coercive relationships, or among vulnerable young adults, as a leading concern 25 26…”

Changes in Documentation Due to Patient Access to Electronic Health Records: Protocol for a Scoping Review

“…Research shows that HCPs are often skeptical about giving patients ORA [12,13], and many of their concerns relate to how PAEHR use might impact their clinical routines, workload, and patient safety [11,[13][14][15][16][17][18][19][20]. Regarding documentation, many HCPs anticipate changing the content and tone of their notes when patients have ORA, which, it is feared, might ultimately compromise the integrity of their records [11,19,21].…”

“…For example, a tendency to avoid technical terminology to facilitate patient understanding could have a negative impact on multidisciplinary communication within the team [21][22][23][24]. Also, some HCPs feel that they may be less detailed or less candid in their documentation and need to omit information or even start using parallel documentation (a "shadow record") to protect patients from information that they consider as potentially harmful or disruptive [14,15,20,[25][26][27]. In contrast, however, there are other voices that assume the introduction of PAEHRs could make notes more patient-friendly by using a more patient-centered and less stigmatizing language and could also stimulate communication between HCP and patients [22].…”