The view of a general practitioner on immediate access for patients to their laboratory test results.

This position paper presents the role of laboratory test results in traditional general practice and provides a recommendation for responsible sharing of results with patients for improved safety, efficiency and outcomes. This paper looks at the relationship between the laboratory, the general practitioner consultation, the patient, safety and general practice capacity. We suggest changes in the traditional practice of communicating laboratory test results whereby normal or abnormal results are made available to patients as soon as they become available. We also endorse the opinion that using online tools such as email or text messages could enhance the provision of rapid access to laboratory test results for patients.

Role of laboratory medicine in collaborative healthcare.

Healthcare delivery and responsibility is changing. Patient-centered care is gaining international acceptance with the patient taking greater responsibility for his/her health and sharing decision making for the diagnosis and management of illness. Laboratory medicine must embrace this change and work in a tripartite collaboration with patients and with the clinicians who use clinical laboratory services. Improved communication is the key to participation, including the provision of educational information and support. Knowledge management should be targeted to each stakeholder group. As part of collaborative healthcare clinical laboratory service provision needs to be more flexible and available, with implications for managers who oversee the structure and governance of the service. Increased use of managed point of care testing will be essential. The curriculum content of laboratory medicine training programs will require trainees to undertake practice-based learning that facilitates interaction with patients, clinicians and managers. Continuing professional development for specialists in laboratory medicine should also embrace new sources of information and opportunities for collaborative healthcare.

Personal health monitoring - exploiting the power of the personal telephone.

Many health issues that we currently face are related to our lifestyle choices. Educating patients can help them to make better informed health decisions. The internet and smartphones, mobile telephones that perform many of the functions of a computer, are becoming more accessible to the majority of the population. Applications on smartphones and professional health websites can signpost patients to trusted information and allow them to co-produce records. Empowering patients, staff and organizations through enabling access to records and understanding, building a partnership trust and the use of social media can enable people to do more and hopefully improve outcomes. In this article, I describe the steps we have taken to facilitate such interactions within our own primary care practice and the response of patients to these initiatives.

Accessing personal medical records online: a means to what ends?

BACKGROUND: Initiatives in the UK to enable patients to access their electronic health records (EHRs) are gathering momentum. All citizens of the European Union should have access to their records by 2015, a target that the UK has endorsed. OBJECTIVES: To identify the ways in which patients used their access to their EHRs, what they sought to achieve, and the extent to which EHR access was related to the concept of making savings. METHODS: An audit of patients' online access to medical records was conducted in July-August 2011 using a survey questionnaire. Two hundred and twenty six patients who were registered with two general practices in the National Health Service (NHS) located in the UK and who had accessed their personal EHRs at least twice in the preceding 12 months i.e. from July 2010 to July 2011, completed the questionnaire. Data analysis A thematic analysis of the comments that patients gave in response to the open ended questions on the questionnaire. RESULTS: Overall, evaluations of record access were positive. Four main themes relating to the ways in which patients accessed their records were identified: making savings, checking past activity, preparation for future action, and setting new expectations. CONCLUSIONS: Quite apart from any benefits of savings in healthcare resources, this study has provided qualitative evidence of the active ways in which patients may make use of access to their EHRs, many of which are in line with proportionate health management strategies. Access to personal EHRs may contribute to the development of new expectations among patients.

The impact of patient record access on appointments and telephone calls in two English general practices: a population-based study.

Background Government policy expects all patients who wish to have online record access (RA) by 2015. We currently have no knowledge of the impact of patient record access on practice workload. Setting Two urban general practices in Manchester. Question What is the impact of patient RA on telephone calls and appointments in UK general practice? Method We asked patients in two urban general practices who used RA whether it had increased or decreased their use of the practice over the previous year. Using practice data, we calculated the change in appointments, telephone calls and staff cost. We also estimated the reduction in environmental costs and patient time. Results An average of 187 clinical appointments (of which 87 were with doctors and 45 with nurses) and 290 telephone calls were saved. If 30% of patients used RA at least twice a year, these figures suggest that a 10 000-patient practice would save 4747 appointments and 8020 telephone calls per year. Assuming a consultation rate of 5.3% annually, that equates to a release of about 11% of appointments per year, with significant resource savings for patients and the environment. Discussion This is the first such study in the UK. It shows similar results to a study in the USA. We discuss the study limitations, including the issue of patient recall, nature of the practices studied and nature of early adopter patients. Strengths include combining national data, practice data and local reflection. We are confident that the savings observed are the result of RA rather than other factors. We suggest that RA can be part of continuous practice improvement, given its benefits and the support it offers for patient confidence, self-care and shared decision-making.

Providing patients online access to their primary care computerised medical records: a case study of sharing and caring.

BACKGROUND: Healthcare systems are struggling to deliver high quality care and constrain costs as more people live longer with a greater burden of disease. Providing patients with access to their records and with practice specific health information may improve the quality of care. OBJECTIVE: To describe one practice's experience of providing patients with access to their primary care records. SUBJECTS AND SETTING: Approximately 12 200 patients, registered with a semi-rural practice based on two sites, have been offered online access to their records. METHOD: A description of strategies used to encourage patients to sign up for access to their records. This includes the development of a practice-based web portal regularly updated with health advice. RESULTS: Six percent of the patients in the practice now have access to their records via an explicit consent process. There are over 100 000 viewings of the practice web portal. There have been no problems as a result of providing access. Further developments include developing a new process for patients unable to provide consent in nursing homes. CONCLUSIONS: This case study provides a model of how to set up patient access to electronic records.

Towards a partnership of trust.

The relationship between doctors and patients is changing as patients live longer but with a greater incidence of chronic disease. An increase in the availability of information about health coupled with the Choice agenda and a patient-led NHS has encouraged patients to learn more about their own health. Patient access to their own GP-held records has led to the development of a Partnership of Trust whereby patients and their clinicians develop a shared understanding of their health and what each do for each other. This could potentially lead to significant patient and clinician benefits ultimately leading to better outcomes for individuals and societies.