Patients’ access to health recordsBMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l5725 (Published 02 October 2019) Cite this as: BMJ 2019;367:l5725
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Hägglund et al have rightly identified the worldwide problem of lack of effective enforcement of regulations which allow or mandate patient record access (1). In India, two regulations provide patients' access to health records. The ‘Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002’ (IMC regulations) mandates to provide a medical record to the patient or authorized personnel within 72 hours of receiving such a request (2). Alternatively, a patient can demand either access/inspection of a medical record or copies of it under ‘Right to information (RTI) Act, 2005’ in which it has to be provided within 30 days of receiving the request. If the information sought for concerns the life or liberty of the patient, the same shall be provided within 48 hours of the receipt of the request (3). The RTI Act is however applicable to public sector hospitals only.
Despite these two regulations being in force, the majority of patients as well as providers are not even aware of them. There are provisions for penalty and compensation in case of delay or denial of information under the RTI Act, but the appeal procedure is lengthy as the appeal disposal currently takes more than a year. The appeal process for violations of IMC regulations is cumbersome and may take years. In effect, the lack of effective enforcement of these regulations is a lost opportunity to empower patients and improve transparency in the healthcare sector.
1. Hägglund M, DesRoches C, Petersen C, Scandurra I. Patients' access to health records. BMJ 2019;367:l5725.
2. Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002. Available from https://www.mciindia.org/documents/rulesAndRegulations/Ethics%20Regulati....
3. Right to information Act, 2005. Available from https://rti.gov.in/rti-act.pdf.
Competing interests: No competing interests
A task group of a European group that I have the privilege of taking a small part in includes a workstream on "Disruptive technology and patient engagement". Amongst other issues the European group is looking at the future in which 770,000,000 European patients will be able to receive their laboratory results at the same tme as or before the doctor.
Samina Munir, Salford Health Informatics Research, environment (Shire), University of Salford, & Dr. Ruth Boaden, Manchester School of Management, University of Manchester Institute of Science and Technology (UMIST) wrote their report “Culture and Change at The Hadfield Medical Centre” in 2001. The report was one of the deliveries from NHS Information Authority Electronic record Development and implementation pilots at Hadfield Medical Centre, Derbyshire, and Bury Knowle, Oxford, Medical Centre.
In their report Samina and Ruth suggested that patient access to records was “Emergent Change: The emergent approach to change views change as driven from the bottom-up rather than top-down. Change is seen as an open ended and continuous process of adaptation to changing conditions and circumstances. The process of change is regarded as a process of learning for all. This approach accepts that many organisations are faced with changing environments and turbulent circumstances and considers these in its approach to organisational change.”
They quoted Burnes (2000) who they said "describes emergent change as: a continuous process of experimentation and adaptation aimed at matching an organisation’s capabilities to the needs and dictates of a dynamic and uncertain environment, a multilevel, cross-organisational process that unfolds in an iterative and messy fashion over a period of years and comprises a series of interlocking projects and a political-social process and not an analytical-rational one.”
They utilised the model of Cummings and Huse (1989): "Many different and varied models describing organisational culture are available. Of these, a model was chosen that best reflects the purpose of this report and best describes the organisational culture at the HMC, who describe culture as 4 elements existing at different levels of awareness within any organisation. These levels are: Basic assumptions, Values, Norms, Artefacts."
The emergent "artefacts" of the Huse and Cummings model in the case of patient access to records are the amazing advances in personal and medical mobile, ITC and electronic record technology. The emergent change in "basic assumption" in the Huse and Cummings model applied to patient access to records is patient access to the record with its associated contribution to the care record and health promotion by patients themselves. The emergent change in "value" in the Cummings and Huse model applied to patient acces to records is of the patient as a contributor to care, and the emergent "norm" of the Huse and Cummings model is the sharing of the contemporary record with the patient (and family, if the patient so wishes).
One further obstacle, perhaps, to the implementation of patient access to records that the editorial does not stress greatly, is the dearth of training about sharing records and notes with patients for medical and nursing students, doctors and nurses, and we hope that training will soon be available for these professionals. We are speaking to one medical school at present to see if we can help to create a one hour module for medical students on the subject of patient access to records.
Munir, S.K. (2000) Patient Empowerment through the Electronic Health Record, A dissertation. University of Manchester Institute of Science and Technology.
Cummings, T.G. and Huse, E.F. (1989), Organisation Development and Change (4th Edition), USA: West
Burnes. B. (2000), Managing Change – A Strategic Approach to Organisational Dynamics (3rd edition), Pearson Education Limited: Essex
Competing interests: No competing interests