The new five-year GP contract in England indicates that practices should be offering new patients online access to their prospective records, and from next year all patients online access to their full records, as part of a wider drive to offer patients more digital services.
It is important to understand the requirements and how to go about digitising patient records efficiently while protecting patient confidentiality.
The UK has a long-standing reputation for leading the development of IT in general practice. The first ‘paperless’ practice and printed scripts were developed here, back in 1975.
The emphasis on digitising of patient records is now shifting so that practices are required to create and maintain records for use by other services and patients, rather than solely for their own use.
As such, records are no longer used only as an aide memoire for the patient’s GP, but also increasingly for performance management, risk stratification, planning services, medical research and crucially for medico-legal purposes.
In line with this, practices are now being encouraged to enable patients to access their own records. In the future, complete digitisation and the ability of patients to access their own full records will supersede the need for practices to provide copies of records for SARs.
However, this requires GP medical records to be digitised completely and accurately. This process involves ensuring that all prospective information and communications are added to the electronic record, and that the back catalogue of legacy paper records is scanned. Wherever possible, all entries should be coded.
The new 2019 GP contract builds on previous IT requirements for general practices. Key requirements on digital records are listed below and full requirements regarding IT can be found on the BMA website.
Implementing these requirements will be dependent upon NHS England providing resources including upgraded IT infrastructure and functionality.
NHS England allocated £1.8 billion for making the NHS paperless over five years, until 2020. As part of this the current GP System of Choice scheme for general practice IT will be replaced by GP IT Futures which is currently under development.
Many of the deadlines should at this stage be considered to be aspirational as there will need to be changes in clinical computer systems as well as additional financial investment, especially for scanning of legacy records. Gain advice from your Local Medical Committee before agreeing to be part of any pilot scheme.
Practices should ensure they are planning how to implement these changes, but unless they have a imperative to do so, should delay doing so until the resources and IT tools are in place.
Every practice is at a different point on the journey to full digitalisation of records, and in preparation should take stock of where they are now. Practices should ensure that they have the following in place or develop a plan to do so:
Key changes for practices under the GDPR and the Data Protection Act 2018
There are different options for digitising the back catalogue of the contents of Lloyd George envelopes. Ideally, they should be scanned into the document management system that the practice already uses, then coded. If scanning multi-page documents separately, for example though a commercial scanning company, the preferred format is Tag Image File Format (TIFF) Version 6.
Prior to scanning, the contents should be trimmed of any documents which no longer have relevance.
There is no requirement for the Lloyd George envelope to be kept once the contents have been summarised and scanned.
There is much confusion about third party data. In essence, if the data has been provided by, or is known by, the patient (data subject) it does not need to removed.
The only exception can be where data is shared by the patient and a third party, which should not be shared with another. For example, if one parent is asking for a child’s record, the other parent’s address, contact details and details of relatives should be redacted.
Other parties adding data to general practice records can sometimes, but not always, be beneficial. Practices where other agencies already add to records will have experienced the downsides – for example, excessive entries may make the record cumbersome to use, and inaccurate entries may distort QOF and other audits, and can affect patient safety. Changing these entries normally requires contacting the originator and asking them to alter it. Ensure that your practice considers all the advantages as well as disadvantages before accepting other bodies adding to the practice’s record.
Many of these changes are still in development. My view is that entries by patients should sit beside, but not within, the electronic record with the ability to accept the information into the main record if appropriate. Online and video consulting should be integrated into the practice software and in line with common practice for telephone consultations recorded.
The development of a complete electronic record, transferred by GP2GP, will have many benefits for practices, although the issue of patients moving between England and other parts of the UK still requires an urgent solution.
Practices should ensure they are planning how to implement these changes, but unless they have an imperative to do so, should delay doing so until the resources and IT tools are in place.
Dr Grant Ingrams is former chair of GPC GP IT Subcommittee, Co-Chair Joint GP IT Committee and Fellow of the Faculty of Clinical Informatics
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