Empowering underserved groups through access to electronic health records
BMJ 2023; 380 doi: https://doi.org/10.1136/bmj.p247 (Published 31 January 2023) Cite this as: BMJ 2023;380:p247
Giving patients access to their electronic health record (EHR) enhances their understanding of their care, empowering them to make informed decisions and better manage their own health, which can ultimately improve outcomes.12 Moreover, it can increase efficiency in primary care.13 Patients in England were promised full access to their GP medical record by the government, but these plans to enable access across all practices through the NHS app from November 2022 were curtailed after concerns were raised about clinical safety and the redaction software tools available.4
The covid-19 pandemic has exacerbated the already weighty demands on primary and secondary care, and improving patient access to EHRs could help to alleviate some of these pressures. Yet, as we continue to roll out patient access to EHRs, we must take care not to perpetuate existing healthcare inequalities,5 instead aiming to minimise these by engaging with patient groups who are under-reached and underserved by healthcare services.67
Haughton Thornley Medical Centre in Greater Manchester has successfully encouraged EHR uptake over the past 17 years, and 81% of patients currently have full access. The centre has learnt five key lessons on how healthcare professionals and policy makers can enable under-reached patients to access their EHR.
Key lessons
Define and identify under-reached groups for the local area
The groups of patients who are underserved by healthcare services will vary from practice to practice depending on the local context and community. Patients may, for example, face language barriers that impede their interaction with healthcare services, or they may have a disability that limits how they can access healthcare or information.67
A database search of patients without EHR access can give practices greater insight into the demographics of those whose needs aren’t being considered in that particular area,8 enabling practices to devise targeted solutions to help these patients easily access their EHR.
Draw patients’ attention to their EHR at every encounter
Many patients will have minimal interaction with healthcare services, making them less likely to be aware of EHRs. Every patient encounter, from in-person appointments to remote consultations, should therefore be used as an opportunity to spark interest in the EHR. At the Haughton Thornley centre we have also created an infographic and short video that patients are directed to when they apply online for an e-consultation,9 raising their awareness of the benefits and risks of EHR access and providing simple registration instructions.
Direct communication with a healthcare professional is key to engagement
A partnership of trust, created through responsible sharing between healthcare professionals and patients, is invaluable in encouraging EHR uptake and engagement. When someone who is directly involved in a patient’s care—from GPs to nurses, pharmacists, and physician associates—talks about EHR access with them it allows discussions to be tailored to each patient’s needs, accounting for their health and digital literacy.
Furthermore, this direct contact supports under-reached patients through the registration process and initial navigation of their record, which patients often don’t feel confident doing alone.10 It also provides opportunities for any concerns to be raised, such as how to manage worrying results,10 and to signpost patients to resources for interpreting health records. After all, providing patients with access to their EHR will largely be futile if they can’t then understand it.11
Investing in a dedicated support system is essential
Practices should have a dedicated support system where all staff play a part either virtually or in person, which is guided by a designated online champion and can help continue conversations sparked by individual healthcare professionals. A support system can ensure that patients complete the registration process, it can manage logistical issues, and it can check that patients are using their EHR correctly, while also obtaining patient feedback to improve the user’s experience of the EHR and engagement.
Although training all practice staff in these skills will require time and money, this investment is essential. We know that patients with low digital literacy or language barriers face substantial difficulties using online systems, often leading to them giving up on accessing healthcare altogether.10 If practices are to prevent this happening the whole team will need to be behind this goal.
Digital services need investment to ensure sustainability
Although policies are being developed to give patients access to their EHR, this needs to be widely supported by further investment from NHS Digital and NHS England to sustain patient engagement. This ultimately depends on the accessibility and affordability of digital platforms, especially for people from underserved groups.
Platforms should have easy-to-use interfaces that allow patients with poor health and digital literacy to engage with them. Even with support from family members, people who don’t speak English as a first language face barriers when accessing EHR platforms, which mainly use English.10 In addition, ensuring that EHR platforms are compatible with inexpensive devices could improve their accessibility. Although this doesn’t guarantee digital inclusion for all, it will limit the possibility of financial constraints excluding even those patients who want to engage with their EHR.10 Investment is also needed to raise patients’ awareness of the benefits of using their EHR and to help them acquire the skills to access remote care.10
Pressures on healthcare
Increasing EHR access is one potential way to alleviate the growing pressures on primary care, particularly by focusing on under-reached groups. We’re inevitably moving into an era where people increasingly engage with healthcare through digital technology, but “seldom heard” communities could be left behind if specific measures are not put in place.
Helping these patients to access their records and navigate the technology can avoid creating another digital divide and can improve access to healthcare for underserved patient groups, helping to tackle existing health inequalities.
Footnotes
Competing interests: none.
Provenance and peer review: not commissioned; not externally peer reviewed.