How one GP gives his patients access to their electronic health records

Doctor Amir Hannan

Doctor Amir Hannan: “My hope is that one day all people in the world will be able to do this. This is the future of healthcare and it is happening now!” Image: supplied

The start of Doctor Amir Hannan’s career was a rocky one. In 2000 he took over the surgery from convicted murderer Doctor Harold Shipman. On their first day, Amir and his colleague found that Shipman’s children had removed all furniture, phones and computers from the practice. Equipment had to be borrowed from other surgeries.

The practice has long since been turned around into a thriving GP clinic with a strong focus on eHealth; for the past 7 years patients have had online access to their electronic health records.

Around the world there are several projects going that allow patients to get access to their records, and Amir Hannan is one of the trail blazers.

He did his medical training at Manchester University and then trained as a General Practitioner in the north-west of England. I got in contact with him after he posted a comment on my blog post about OpenNotes, and he was kind enough to talk to me about his amazing pioneer work.

Empowering patients

Mobile screenshot

Dr Amir Hannan: “You can do all these things via smart phone, tablet or PC.” Image: supplied

Amir is passionate about the project: “I am motivated by the desire to do the very best for patients and staff by bringing out the best in all of them. Empowering them, empowers me. When they benefit, I get an immense sense of achievement. It becomes infectious and helps me to overcome any challenges I may face.”

The practice administration and clinical system he uses in his practice is called EMIS, widely used by GPs in the UK. Amir: “EMIS also provides a secure online facility for patients, called ‘Patient Access’, which allows patient access from a range of internet devices.”

What are the benefits?

Amir says the system offers many advantages:

“Benefits include a more open relationship with patients, which enables patients to feel more in control. They can book appointments online, order prescriptions online, update their contact details and access the full records if they wish. This helps patients to read what the doctor or nurse has said, see test results or letters as soon as they arrive back in the practice, check for any errors or missing data and help with completing medical and insurance forms.”

“It improves the relationship between patient and clinician, leading to a partnership of trust.

“Information buttons provide links to trusted information so that patients do not have to do a Google search. You can do all these things via smart phone, tablet or PC.”

“It improves the relationship between patient and clinician, leading to a partnership of trust. Patients use it intelligently saving their time and doctors’ time to make the system safer and more efficient.”

“Patients can send secure messages electronically, write into the surgery on paper and their comments can be added to the record or they can complete an Instant Medical History which we have recently introduced. We do not encourage email as it is not a secure means of communication and our replies could be seen by other family members which may compromise the patient’s right to confidentiality.”

“We need to do further studies to prove patients accessing their records and, most importantly, understanding them, do in fact enjoy better outcomes such as improved blood pressure control, diabetes care or reduced time off work. Anecdotally patients seem to have better compliance of treatment and we have many testimonials from patients describing their positive experiences. Such evidence may become available as more patients sign up.”

What are the risks?

Amir feels his patients are more in control of their health and care and, at least anecdotally, there seem to be some benefits. But are there any downsides?

“We take security and privacy very seriously. The software requires patients to register using their pin numbers for the service and then use passwords to get access to their records. This seems acceptable to the patients. We have not had any data breaches to date. We offer advice for patients to help them understand these issues better.”

“Very few patients ring the surgery because they do not understand something and we have not been sued for anything as a result of giving patients access to their records. In fact we are still waiting for our first complaint and that’s after offering the service for over 7 years. Currently over 2650 patients, 23% of our registered patient population, have access to their records. Records sharing is safe and does not increase litigation.”

“Every encounter afterwards can lead to patients learning more about their symptoms and how they can do more for themselves.

“It does take some time for patients to sign up for online services, and we do have an explicit consent process. Patients are asked to get their pin numbers from the receptionist, look at some of the support material which explains what records access is, and then complete an online questionnaire which confirms their understanding of the issues. Their request then has to be processed which takes about 10 minutes per patient.”

“It is a journey of discovery for patient and clinician so that every encounter afterwards can lead to patients learning more about their symptoms and how they can do more for themselves. Paradoxically, this seems to lead to a reduction in anxiety because patients, carers and family can check what has been said, see that the practice has done what it agreed to do, gain a better understanding of their health and improve their health literacy – patients worry less as a result.”

Amir’s practice offers the service for free to patients, although there is no funding in the UK to support practices to engage with their patients online. Amir: “Our implementation using the practice-based web portal has required the practice to provide its own resources. The current strategy locally has been for the market to drive innovation, which has failed completely. Funding will need to be made available to encourage innovation and enable stretched practices to invest in such tools to gain maximum benefit and to scale this.”

Tips

The UK Royal College of General Practitioners has published a guide titled Enabling patients to access electronic medical records. A guide for health professionals. Amir recommends this to anyone who is interested in setting up a similar system.

“My hope is that one day all people in the world will be able to do this. This is the future of healthcare and it is happening now! See how others are doing it, such as in the UK: PatientView or in America: Kaiser Permanente and OpenNotes.”

“I use my twitter account to share experiences with others.

“It is not easy and it takes time, resources and effort. Build links with others and collaborate with them to share experience and knowledge. Build a practice-based web portal such as ours, which helps to engage with patients and provides a mechanism of informing, signposting, engaging and empowering patients and their carers. Engage on twitter and social media – there is a great deal of interest. I use my twitter account to share experiences with others.”

“Listen to your patients and staff. Work with them and develop a strategy and a plan. Most importantly get on and do it. Don’t procrastinate or worry about what might happen – instead think about the opportunities and consequences of enabling patients to access their records and understand them.”

“My practice manager Wendy Smallwood and the patient chairs of our patient participation groups Ingrid Brindle and Eleanor Simmons are stars!”

Follow Dr Amir Hannan on Twitter.

19 thoughts on “How one GP gives his patients access to their electronic health records

  1. I’d be interested to know how much time is required to help patients with the log in process, resetting passwords etc. in principle a good idea if it can be managed safely and cheaply

    Liked by 2 people

  2. Hi Ed & Mark. Sounds interesting especially wrt compliance issues. Having just seen a presentation on the woeful compliance issues in the chronically ill that alone would seem to be a benefit. I have some Qns around young children becoming mature minors or partners in domestic violence situations wrt privacy and access.

    My patients can see whatever part of the record they like with a rare exception (usually psych). Interestingly talking about access with a patient yesterday who assumed that she “owned” her record. Which I appreciate in this consumer driven world but as we know is not (at this point) strictly correct. Sounds like his admin support is excellent but the cost and ROI would need to be explored further in the Australian context. Having access to results as they come in. THAT mammogram. Does that mean the patient then needs a response immediately if she has accessed on a Sunday. (For instance).

    It seems to work here though. A stark contrast to the previous owner.
    Great find Ed.

    Kp x

    Liked by 1 person

  3. Amir has been kind enough to give me some of his time in the past to talk through his work also.

    One thing that struck me as especially valuable is that his patients can also access a wide range of credible information via the same site. So if they see for example a slightly abnormal test result and wonder if they need to worry, they can look it up. This in turn would reduce unnecessary anxiety. It does of course work alongside other actions that the practice takes to handle abnormal results.

    Complementing a patient’s own record with resources that they can access alongside it on such a wide range of topics is likely to add significant value and is worthy of consideration.

    Thanks Edwin – great post.

    Liked by 1 person

  4. “The appointment system and the 3rd way” has just been published on our Facebook page. Here you can see patients of ours describing their own experiences as well as some of the leaders in the NHS talking too.

    https://www.facebook.com/pages/Haughton-Thornley-Medical-Centres/646733828696947

    You are now witnessing the impact of giving patients access to their records and understanding too. This brings a whole new dimension to interaction with empowered patients and gives them a direct opportunity to interact with you even if you are on the opposite side of the planet.

    The world isn’t that different after all!

    Like

  5. I really like this idea. In fact I really like the whole idea of the e-health record. My biggest concern with teh proposed Australian system is the ability for patients to decide what information is excluded from their record. I would be mighty unhappy, f’rinstance, if a hep C positive carrier decided this information should not go in their e-health record. WHat happens then if I send the information to their admitting surgeon and anaesthetist? What about the trauma department who look after them when they have a major accident? Personally I think it needs to be a complete record or opt completely out- I know this is not exactly on track fore the post but would love to hear what others think

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    • Big problem indeed. That’s why I like Amir’s solution: patients can give their GP feedback about the quality of their health data and take more control.
      Making certain info invisible as w PCEHR is understandable from a pt pov but clinicians will never rely on the info. I believe the PCEHR was (interestingly) never intended to be a complete record.

      Like

  6. So true Olga & Ed. A medical record is not a Facebook profile page. Without it being complete it renders it useless. Leaving out medication eg: anti depressants, anti psychotics Viagra or diagnoses renders it a non medical record.
    Unworkable for clinicians and especially in an ED setting where a patient may not be in a state they can communicate.

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  7. I hate this idea so much, but am pleased it’s working for this clinic. If a patient wanted to get more involved in their care now, they could ask me for a print-out of results or bring a USB/memory stick to their appointments, and ask for copies of letters and so on. Very few of my patients are motivated enough to do this and those that do keep their own medical files, I tend to think of as over-zealous.

    I loathe the idea of patients having access to results before I do (think nightmarish scenarios of people seeing HIV or cancer results without a medic there to explain it to them [I even see potential suicides there], or people misunderstanding their results – taking them more or less seriously than they should be). Having access 24/7 also means increased demands on GPs (eg. patient works themselves into state of panic when seeing a result at 1am in the morning – are they going to go to ED? I won’t be on-call for them 24/7).

    But most importantly, I need a record that I can use to write observations on the patient that I’m fairly confident they won’t see most of the time. It’s their record….but it’s not. In Australia currently, my patients are entitled to their record, but rarely ask for it. When they make a request for their notes, (after ringing my insurer), I sit them down and go through the notes with them, explaining they may read things they don’t like or that are in technical jargon. I am likely to cease seeing someone who wants free access to their notes – they need to see a different GP, I am not the GP for them. I need somewhere to record observations like:
    – “smells strongly of urine, looks dishevelled, really need to get family in for a meeting soon”
    – “difficult consult, hostile at times” to explain why a consult went a particular way with a challenging teenager
    – mental state exam findings that raise suspicions for a personality disorder
    – reminders to myself for the next visit
    etc etc

    Totally agree re: PCEHR comments from medics above, that an incomplete record is not a workable medical record. It is precisely the exclusions that need to be included for a patient to receive safe care.

    Like

  8. Reblogged this on Dr. Tavares' Blog on Patient Safety and commented:
    Dr. Hannan: “It is a journey of discovery for patient and clinician so that every encounter afterwards can lead to patients learning more about their symptoms and how they can do more for themselves. Paradoxically, this seems to lead to a reduction in anxiety because patients, carers and family can check what has been said, see that the practice has done what it agreed to do, gain a better understanding of their health and improve their health literacy – patients worry less as a result.”

    Like

  9. I loved to read the interview “How one GP gives his patients access to their electronic health records”. Dr. Hannan is an example to be followed. He shows us how to implement a Patient and Family Centre Care practice in reality. By being completely transparent, he is joining his patients forces in their common goal of achieving the best care of his patients. I will share his example in Canada. Reading his story I fell we are way behind what is happening in the UK. Great job! Thanks for sharing. Alex

    Liked by 1 person

  10. Pingback: Electronic Health Records in the UK: Patient Access Remains a Hot Topic

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