US experience with doctors and patients sharing clinical notesBMJ 2015; 350 doi: https://doi.org/10.1136/bmj.g7785 (Published 10 February 2015) Cite this as: BMJ 2015;350:g7785
All rapid responses
As Jan Walker and colleagues say (1), the move to providing patients with online access to records is accelerating – here as well as in the US. Currently, UK general practices have an obligation to provide patient online access to the Summary Care Record. Under the 2015-16 contract, there will be a requirement that practices offer patients online access to all coded information in their record, see http://bma.org.uk/working-for-change/negotiating-for-the-profession/bma-....
There is a growing body of evidence suggesting that patients report positively on online access to their records (2), including the study described by Jan Walker and colleagues (3). However, as in this US study, these patient groups tend to be narrowly defined – to be older, wealthier patients and to largely exclude the vulnerable and those with stigmatised conditions such as substance misuse (2).
We would like to know whether the same positive experiences would be reported by adolescents who might be expected by parents to share their online health records or for adults who are in abusive and controlling relationships at home. In the study described by Walker and colleagues, approximately 1 in 3 participating patients reported some concerns over privacy of online access and 1-8% of participating patients agreed that online access caused confusion, worry or offense (numbers varied across sites) (3). We don’t have any further details about these patient concerns. Given the low uptake (42%) and response rate (41%) across sites, these responses might represent a group of patients who are particularly internet savvy and keen on online access (3).
Like the authors of a recent piece in JAMA (4), we see that online access might in some cases deter patients from seeking healthcare or making full disclosure of relevant problems because of a fear that a parent or household member might see the health record. We would welcome studies that collected examples of how individual GP practices or federations had responded to these problems or that increased our understanding of how online access can work in younger or more vulnerable groups.
1. Walker J, Meltsner M, Delbanco T. US experience with doctors and patients sharing clinical notes. BMJ 2015;350.
2. Mold F, de Lusignan S, Sheikh A, Majeed A, Wyatt JC, Quinn T, et al. Patients' online access to their electronic health records and linked online services: a systematic review. BJGP In press.
3. Delbanco T, Walker J, Bell SK, Darer JD, Elmore JG, Farag N, et al. Inviting patients to read their doctors' notes: a quasi-experimental study and a look ahead. Annals of internal medicine 2012;157(7):461-70.
4. Bayer R, Santelli J, Klitzman R. New challenges for electronic health records: confidentiality and access to sensitive health information about parents and adolescents. JAMA 2015;313(1):29-30.
Competing interests: No competing interests