What do primary care staff think about patients accessing electronic health records? A focus group study

Abstract

Background Patients have expressed a growing interest in having easy access to their personal health information, and internationally there has been increasing policy focus on patient and care records being more accessible. Limited research from the UK has qualitatively explored this topic from the primary care staff perspective. This study aimed to understand what primary care staff think about patients accessing electronic health records, highlighting errors in electronic health records, and providing feedback via online patient portals. Methods A focus group study involving 19 clinical and non-clinical primary care staff. Primary care practices were purposively sampled based on practice size and the percentage of patients using online services. Data were analysed inductively using reflexive thematic analysis. Results Three themes were generated: (1) Information – what, why and when? (2) Changing behaviours and protecting relationships, and (3) Secure access and safeguarding. The emotional considerations and consequences for staff and patients featured prominently in the data as an overarching theme. Conclusions Primary care staff described being invested and supportive of patients accessing their electronic health records, and acknowledged the numerous potential benefits for safety. Uncertainty around the parameters of access, the information available and what this might look like in the future, processes for patients highlighting errors in records, relational issues, security and safeguarding and equitable access, were key areas warranting examination in future research.

Adapting to transparent medical records: international experience with “open notes”

“…Every new entry made in the primary care record will be immediately visible to patients, including the free-text consultation entries (commonly referred to as “open notes”). Clinicians are understandably concerned about this radical change in practice, fearing additional burdens for their work, an onslaught of calls or emails from anxious or confused patients, and potential risks to patients’ safety 45…”

Implications of the changes to patient online records access in English primary care

“…6 NHSE explored the experiences of 16 'early adopter' sites who enabled full prospective access before November, 1 and found most sites did not see noticeable increases in workload, with some reporting reductions due to fewer subject access requests and test result queries. Concerns about workload related to complaints or litigation arising from ORA have also been raised; 8,9 however, findings from the US, where ORA has been the default since April 2021, have found no clear evidence for increased risk of litigation. 10…”

“…The impact of ORA on safeguarding is a common concern. [7][8][9] There is potential for patients to be put at risk through unauthorised or coercive access. Clinicians are concerned that it is now more difficult to alert their colleagues by documenting suspicions about possible child/domestic abuse or issues such as drug use, as they cannot be sure who might view the record.…”

“…Clinicians are concerned that it is now more difficult to alert their colleagues by documenting suspicions about possible child/domestic abuse or issues such as drug use, as they cannot be sure who might view the record. [7][8][9] Staff who enter information into the record must now consider when to hide such entries from the patient online view, and NHS Digital have provided guidance regarding why, when, and how to do this. 1 It is not currently possible to redact parts of a consultation entry, only the entire consultation.…”

“…Records access has the potential to exacerbate health inequities, [7][8][9] further disadvantaging those whose first language is not English, or who have lower literacy levels, poor digital skills, sensory needs, learning disabilities, or limited IT access. [7][8][9] Evidence from the US shows that age, education, ethnicity, and language do impact on online records access, but when individuals from disadvantaged groups use these services they report even greater benefits than other users. 5 We must ensure that groups who could be disadvantaged by ORA have supportive options available, such as translation services, patient advocates, or alternative formats.…”