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Rapid Responses: Rapid Responses published:
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Medical records
- GEORGE Y CALDWELL, SINGAPORE 259858. (8 May 2008)
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Health care in for a massive change - driven by generation X and Y
- Alec Holt (9 May 2008)
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Access to your own GP record is available now.
- Brian H Fisher, SE 26 6JQ (10 May 2008)
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HealthSpace Direction
- Gillian A Braunold (13 May 2008)
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All or none
- John J McNeil (14 May 2008)
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Wow!
- Graeme Mackenzie (15 May 2008)
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Patient's take control over their own health records with MedicAlert
- Jo Cartwright (15 May 2008)
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GEORGE Y CALDWELL, GENERAL PRACTITIONER 31 BALMORAL PARK, #18-33,, SINGAPORE 259858.
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When it was decided to open Medical Records to the Public, no distinction was then made between the real detailed factual Records and a doctor's opinion. This just pleased the Lawyers. Of course everyone should have access to his Records so that he can take them with him/her wherever they go. But the doctor's opinion is confidential and must not be disclosed. These essential records could be encrypted on a plastic Medical Card carried by the patient who very often forgets when or for what he/she had some surgery. It will have the important details of Allergies, Blood Group etc. and all previous ailments as far as possible. One swipe of the Card will reveal all that is necessary. When the time comes for a General Practitioner to be paid and recompensed for each item of work he does, as in the far distant past, then this Card will be useful in crediting his account for the work done. In an instant. A salaried doctor becomes a lazy doctor. If from the beginning of the NHS he had been able just to present his Bill to the Government for payment it would have saved much mayhem and he would have been a happy bunny from the outset. How fast could these electronic records be transmitted from Clinic to Clinic? The Medical Card will take the place of the expensive Identity Card. I've still got mine. Competing interests: None declared |
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Alec Holt, Director of Health Informatics University of Otago
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Microsoft’s HealthVault and Google Health are on the cusp, however expect more and massive changes in the future. Microsoft might acquire Facebook and we have Web x.x on the horizon. It is not just health records that consumers are wanting access to. They want to know about similar patients and more information on their drug combinations. See patients like me (http://www.patientslikeme.com/), DoubleCheckMD (http://www.doublecheckmd.com/), PharmaSurveyor (http://www.pharmasurveyor.com) and Drug Interaction Database Online (https://druginteractions.epnet.com/) allow individuals (and doctors) to mine huge amounts of information to assess their own drug combinations. I disagree with Kidd (2008) in that I do not think the NHS's connecting for Health initiatives “the summary care record” and “HealthSpace.1 2” are too little too late. This space is very fluid and fast moving and currently “personally controlled health records” and consumer empowerment will continue to grow exponentially Mandl et al. (2008) and Steinbrook (2008). I do however totally agree with Kidd (2008) that with increased technology and increased use of the internet in the community. The power has shifted to the consumer. The new technologies with the new applications will push the ICT uptake in the health sector. Generation Y, for example, are immersed in ICT, readily using Web 2.0 and Mobile technologies. The convergence of technology is moving so fast and the benefits for the Doctor and patient are immense. Twitter is an example of increased technology and increased sophistication of use of the internet in the community. It is a micro blogging tool that could solve much inefficiency for free. For years, hospitals have being weighing up technologies to get point of care details into to a live database. Now with a Mobile phone (no wireless network needed) health professionals can push short messages to a micro blog site for many different users to see and analyse (tweet clouds) the information. Not to mention the impact of the iphone. Twitter (http://en.wikipedia.org/wiki/Twitter) is a social-networking tool. It enables networking and micro-blogging service that allows users to send "updates" (or "tweets"; text-based posts, up to 140 characters long) to the Twitter website, via short message service (on a mobile phone), instant messaging, or a third-party application such as Twitterrific or Facebook. Kidd, M. R. Editorials: Personal electronic health records: MySpace or HealthSpace? BMJ, doi:10.1136/bmj.39567.550301.80 Mandl KD, Kohane IS. Tectonic shifts in the health information economy. N Engl J Med 2008;358:1732-7. Steinbrook R. Personally controlled online health data—the next big thing in medical care? N Engl J Med 2008;358:1653-6 Competing interests: None declared |
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Brian H Fisher, GP Sydenham SE London, SE 26 6JQ
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It is disappointing that technical difficulties contributed to poor uptake. The pilots corroborate experience in Scotland and elsewhere that most people are happy to have their records shared, particularly those with significant conditions - they immediately see the benefits. Currently, both Microsoft and Google are offering the same facility as HealthSpace: patients can upload information that they currently hold about their health to secure vaults and share that with whomever they wish. In this study, few people wanted to do that. However, we do know, as Kidd points out, that pateints are keen to have access to their full record, in order to see results, letters and consultation records. This facility has been available to patients in all EMIS practices for a year or so. Patients, individually authenticate themselves and, on a web-browser anywhere in the world, can see their full GP record reformatted so that it is easier to navigate around. In addition, the data is automatically linked with health information so that readers can understand better what they read. It may soon be possible to add Web 2.0 options. 40 practices have registered to offer this free service. Inital (as yet unpublished) research commissioned by NHS Connecting for Health shows that patients are enthusiastic and using it in ways that we had not anticipated. We think that this approach will, indeed change the face of healthcare for the better. The approach seems safe and the benefits for both patients and clinicians, as seen in Kaiser and the Veterans Health Administration, will be significant. British Journal of General Practice, June 2007 pp507-510 Competing interests: I am co-director of PAERS Ltd which enables patients to see their full GP record online. I am also funded by EMIS as Record Access Collaborative Lead, bringing people together around the world who are interested in patient record access. |
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Gillian A Braunold, Clinical Director Summary Care Record & Health Space NHS Connecting for Health Vantage House Leeds LS1 4HT
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Professor Kidd raises some interesting questions about the choice between government managing patient access to electronic health records and patients managing their records themselves- reference editorial BMJ 09.05.08. The UCL evaluation of HealthSpace in conjunction with Summary Care Record http://www.ucl.ac.uk/openlearning/documents/scrie2008.pdfl has taken place over a very small part of what HealthSpace is being designed to offer. The unique position that HealthSpace will fill is a secure on line environment for patients to be able manage their transactions with the National Health Service. So not only will patients have the ability to be able to view their records, letters and other information such as in other patient held electronic systems, but also to be able to securely communicate with their clinicians and to contribute to their records. The development of HealthSpace as a secure portal for patients with a digital healthservice will strategically enable a route to change in the clinician patient partnership and I believe will be valued by the citizens for whom it is offered as a tool. Dr Gillian Braunold MB BS FRCGP
Competing interests: Clinical Director Summary Care Record and HealthSpace NHS Connecting For Health |
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John J McNeil, Head, School of Public Health & Preventive Medicine Monash Medical School, Alfred Hospital
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One aspect of the electronic record which worries me is its potential to be incomplete. If patients can allow certain information to be uploaded but veto other information, then electronic records could be more of a hazard than a help. For a record to be clinically useful doctors must have an appreciation of the accuracy and comprehensiveness of the information provided. It might be argued that in clinical practice patients are not always fiorthcomming with information, but in this situation, with the patient in front of them there is more of a chance to probe for important information and to form an impression of its reliability. This is lost with an electronic record. My view is therefore that, while patients may have a right to veto the inclusion of their clinical information in an electronic system, they should not have the right to censor specific parts of the record. If clinicians can not rely on the comprehensivemness of the information, as well as its accuracy, then the electronic record will be of very little value to them Competing interests: None declared |
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Graeme Mackenzie, OUT OF HOURS GP North Cumbria
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I am interested in computer medical records. I am very much against the expensive, totalatarian NHS care record system. Not only will it likely always be inaccurate and require the doctor to retake the past medical history anyway, the potential for abuse is huge. People don't object to having their details on the system because they have not thought through the possible implications. However I had never considered that patients could become responsible for their own internet health record and then just agree what we added (two screens needed in consulting rooms rather than one!). I could then keep my own records of the consultation for my own purposes which presumably were owned by me and could only be accessed with my consent. I was always puzzled when the NHS programme was proposed that notes taken by me in the past to enable me to do my job properly and efficiently were suddenly not my property. I always felt the NHS should pay (handsomely) for my years of work. It was never even considered. Internet solutions keep everyone happy. Oh complex world! Competing interests: None declared |
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Jo Cartwright, Education and Policy Manager 1 Bridge Wharf, 156 Caledonian Road, London. N1 9UU
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In response to the article ‘Personal electronic health records: MySpace or HealthSpace?’ the MedicAlert Foundation is the only UK charity providing emergency medical identification to people with hidden medical conditions, advance decisions, organ donation wishes and personal identification. Each member receives an emblem worn as a bracelet, necklet, sports band or watch. The emblem has their main medical conditions or advance wishes, personal id number and the emergency line phone number engraved on the reverse. An emergency professional can then retrieve the vital information immediately from the emblem and act upon it; following this they can retrieve a much more detailed health record and next of kin information by calling the 24 hour emergency line. With over a quarter of a million members we believe that patients do want to take more direct control of their own personal health information. With MedicAlert, patients decide which information they would like to store on their health record and what they would like displaying on their emblem, in conjunction with a discussion with a member of our specially trained team of nurses and doctors, to ensure accuracy and completeness of the health record. In addition to this the vital information about hidden conditions being immediately available can be life saving as well as giving patients piece of mind and a sense of control. For more information contact: Jo Cartwright, Education and Policy Manager, The MedicAlert Foundation. jcartwright@medicalert.org.uk Competing interests: I work for the MedicAlert Foundation |
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