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The BMA has adopted an old fashioned, paternalistic, and misguided
policy by warning against patients having access to their electronic
records.
We disagree with the BMA on a principle: data about the patient
belongs to the patient. The clinicians who enter data did so as part of
the care they are paid to provide for patients. Giving patients access and
control over their records is fundamental to a health service that is
truly patient centred.
The BMA has based its report on prejudice rather than evidence. Early
trials are clear that patients, including patients with mental health
problems, accessing their records have more benefits than harms (1-3).
Furthermore, the traditional fear that patients would overwhelm doctors
with emails have been proved wrong repeatedly. In the most consumerist
health care market in the world, the US, patients respect their doctors'
time. Large studies by Kaiser Permanente have shown that doctors save time
by working online (4).
Many patients have multiple records in different institutions, and
it's a bureaucratically and legally complex process for those institutions
to share records. But if patients control the records then they can easily
make them available to anybody they want, including close relatives who
may be their carers. Such sharing underpins continuity of care.
The BMA, is however, right that there is a problem giving patients
access to notes that were written by doctors who thought that they would
be read only by other professionals. The notes are full of statements that
doctors do not feel comfortable with patients seeing. So we recommend that
all notes written on or after 2012 should automatically be made available
to patients, under the control of each patient, by law. Before then,
written records should be excluded, unless the patient makes a formal
request using existing channels. Test results, prescriptions and procedure
records should be made available.
Medical notes are more than objective data. They allow valuable
hypothesis generation and testing as each patient's differential diagnosis
evolves. Doctors are rightly anxious that they don't know how to do this
in a way that is comfortable for patients. Medical schools have failed to
teach how to write down such hypotheses in a way that is clinically useful
but not anxiety-inducing. This is why we are working with UCL medical
school and Great Ormond Street Hospital to create a course for junior
doctors that teaches them how to write in the notes on the assumption that
patients will have instant and complete access to the writing. Whatever
the BMA may think, this is the future.
We will provide the course to others around the world and hope that
the BMA embraces education of clinicians rather than shutting out patients
from their own records..
Mohammad Al-Ubaydli, founder and chief executive, Patients Know Best
Richard Smith, chair, Patients Know Best
Competing interest: Patients Know Best is a company that uses
information technology to enhance patient clinician partnership.
1 Ross SE, Lin C-T. The effects of promoting patient access to
medical records: a review. J Am Med Inform Assoc. 2003;10:129-38.
2 Cimino JJ, Li J, Mendonca EA, Sengupta S, Patel VL, Kushniruk AW.
An evaluation of patient access to their electronic medical records via
the World Wide Web. Proc J Am Med Inform Assoc. 2000:151-5.
3 Stein EJ, Furedy RL, Simonton MJ, Neuffer CH. Patient access to
medical records on a psychiatric inpatient unit. Am J Psychiatry.
1979;136:327-9.
4 Chen C, Garrido T, Chock D, Okawa G, Liang L. The Kaiser Permanente
Electronic Health Record: transforming and streamlining modalities of
care. Health Aff. 2009;28(2):323-3.
Competing interests:
Patients Know Best is a company that uses information technology to enhance patient clinician partnership.
The BMA has adopted an old fashioned, paternalistic, and misguided policy by warning against patients having access to their electronic records
The BMA has adopted an old fashioned, paternalistic, and misguided
policy by warning against patients having access to their electronic
records.
We disagree with the BMA on a principle: data about the patient
belongs to the patient. The clinicians who enter data did so as part of
the care they are paid to provide for patients. Giving patients access and
control over their records is fundamental to a health service that is
truly patient centred.
The BMA has based its report on prejudice rather than evidence. Early
trials are clear that patients, including patients with mental health
problems, accessing their records have more benefits than harms (1-3).
Furthermore, the traditional fear that patients would overwhelm doctors
with emails have been proved wrong repeatedly. In the most consumerist
health care market in the world, the US, patients respect their doctors'
time. Large studies by Kaiser Permanente have shown that doctors save time
by working online (4).
Many patients have multiple records in different institutions, and
it's a bureaucratically and legally complex process for those institutions
to share records. But if patients control the records then they can easily
make them available to anybody they want, including close relatives who
may be their carers. Such sharing underpins continuity of care.
The BMA, is however, right that there is a problem giving patients
access to notes that were written by doctors who thought that they would
be read only by other professionals. The notes are full of statements that
doctors do not feel comfortable with patients seeing. So we recommend that
all notes written on or after 2012 should automatically be made available
to patients, under the control of each patient, by law. Before then,
written records should be excluded, unless the patient makes a formal
request using existing channels. Test results, prescriptions and procedure
records should be made available.
Medical notes are more than objective data. They allow valuable
hypothesis generation and testing as each patient's differential diagnosis
evolves. Doctors are rightly anxious that they don't know how to do this
in a way that is comfortable for patients. Medical schools have failed to
teach how to write down such hypotheses in a way that is clinically useful
but not anxiety-inducing. This is why we are working with UCL medical
school and Great Ormond Street Hospital to create a course for junior
doctors that teaches them how to write in the notes on the assumption that
patients will have instant and complete access to the writing. Whatever
the BMA may think, this is the future.
We will provide the course to others around the world and hope that
the BMA embraces education of clinicians rather than shutting out patients
from their own records..
Mohammad Al-Ubaydli, founder and chief executive, Patients Know Best
Richard Smith, chair, Patients Know Best
Competing interest: Patients Know Best is a company that uses
information technology to enhance patient clinician partnership.
1 Ross SE, Lin C-T. The effects of promoting patient access to
medical records: a review. J Am Med Inform Assoc. 2003;10:129-38.
2 Cimino JJ, Li J, Mendonca EA, Sengupta S, Patel VL, Kushniruk AW.
An evaluation of patient access to their electronic medical records via
the World Wide Web. Proc J Am Med Inform Assoc. 2000:151-5.
3 Stein EJ, Furedy RL, Simonton MJ, Neuffer CH. Patient access to
medical records on a psychiatric inpatient unit. Am J Psychiatry.
1979;136:327-9.
4 Chen C, Garrido T, Chock D, Okawa G, Liang L. The Kaiser Permanente
Electronic Health Record: transforming and streamlining modalities of
care. Health Aff. 2009;28(2):323-3.
Competing interests: Patients Know Best is a company that uses information technology to enhance patient clinician partnership.