Patient Access to Records & Transactional Services (PARTS)

Patient Access to Records & Transactional Services

(PARTS)

Welcome to the project launch.

Please note that this event will be recorded.

If you are joining by Webex, please do not close the page, we are due to begin shortly.

Patient Access to Records & Transactional Services

(PARTS)

Tad MatusChief Information Officer

Patient online access to GP services and records, including:• book appointments • request repeat prescriptions • access test results • review medical history (consultations, diagnoses..)• view letters : GP and other health professionals• find out more about condition and treatment• securely message clinicians

What is “PARTS”?

Currently…

• over half GPs have technical capacity to provide electronic access to records but less than 1% do.

•70% could offer transactional services, 30% do.

Power of Information

Key Ambition:

“A change in culture and mind-set, so that our health and care professionals, organisations and systems recognise that the information in each of our own care records is fundamentally about us – and so that it becomes routine for us to be able to access our own records online.”

Power of Information

Commitments:

• All NHS Patients will have secure online access, where they wish it, to their personal GP records by 2015

• Patients will be able to view online which GP Practices offer online access to records by 2013

Project Aims

Establish demonstrator GP practice sites across Kent, Surrey and Sussex to:• Raise awareness of solutions, opportunities and

benefits• Identify barriers to adoption and use• Recommend actions to address these• Inform and shape future roll-out strategies

nationally and locally

Products

1. Benefits evaluation and case studies2. Implementation Toolkit containing good practice

examples3. Status report: implementation, usage and

attitudes4. Follow-on recommendations to address risks

and issues5. Local network of PARTS practices and local

champions

Objectives for Today

• Raise awareness of the project• Explore the drivers for the project; why PARTS and

why now? • Find out what’s already been achieved elsewhere

for patients, practices and the NHS • Establish what GP systems can do / will do• Bring key stakeholders to join the

discussion and get involved

“Systems” for CitizensNo Systems about me, without me

Toto Anne Gronlund(and Philip Green)

The challenge

Seeing the patient as an active partner in care is a major cultural

shift ...but we can feel there is real life in this.The buzz is as palpable as these smiles.

“The power of being practical”

Then amiracleoccurs

The paper chase

JW99

Benefits Management

GP & record

The elephant in the room

The Elephant in the RoomPhilip’s story

With thanks to Philip Green, the story teller, and Pip Hardy and Tony Sumner of Pilgrim Projects, who provided the inspiration and technologies

Why is information important?

Up to 70% of a professional’s time is spent on

information

How much of the patient’s time is

spent on worrying about not having

information ?

Cartoon with thanks to the British Medical Journal

Patients and information are the two most under-used resources in the NHS

Dr. Richard Fitton

Information is one-sided powerShared information is a relationship of trust

Information Governance is there to protect the patient, not the organisation or the professional Dame Fiona Caldicott

Text Text

World class Data Open Outcomes

Patient Voiceand Insight

Customer choiceand control

Transparency

Participation

Knowledgefor all

16

The visionCornerstones to delivering

transformation

Transparency and participation have transformed customer service in other sectors… so why not healthcare?

SOURCE: Financial Fraud Action UK

Consumer applications offered with digital banking

Online banking – a consumer success story ▪ Launched in the US in 1994 and in the UK in 1998▪ Now >22M adult users (>50% of computer users)

Access to records Online banking offers

access to personal bank account applications in a secure environment

Healthcare equivalent: access to the medical record

Ability to transact Customers pay bills and

receive payments Healthcare equivalent:

ability to receive test results

Ability to book appointments

Online banks offer real time facilities to book meetings and calls with advisers

Healthcare equivalent: ability to email your doctor

17

With thanks to live|work, Ealing PCT and the MS patients

Some observations by the G6• If patients and people are not involved, how do

we know that we are defining, collecting, accessing, sharing, analysing, using and reporting the right information to enable safe, quality care.

• If we can’t see our records, how do we know they are right?

• Who owns the data (does it matter) vs who has access to the data.

• IG will become a patient responsibility too.• Information can be a ‘service’, decision aids,

online selfassessment, peer groups, as well as record access

If Electronic Health Records remain electronic versions of the paper record, we will continue to get the same results as we did before, only faster.

What is happening....G6, patient members and patient organisations now submitting ‘requirements’ for improvements to GP IT systems

Patients joining System User Groups.

GP2GP programme is working in targeted areas to increase patient awareness

Draft of Safe Record Keeping Guidance for patients now complete – (BCS / G.Mynors)

NHS North producing guidance and supporting practices and a diverse network of people supporting the RCGP led collaboration

What will help....

• Clinical leadership & trust in your patients• The factorial expansion of information• Being pragmatic and creating a sustainable

approach• Systems that are accessible• A healthy dose of emotional intelligence• Transparency• Beacons like PARTS !

“Well, you would be forgiven for thinking that right now patients have used their new found health informatics just to look stuff up, seek out fellow suffers for mutual support, and – if they are lucky – to order the occasional repeat prescription online.But behind these mundane uses, a revolution is indeed gathering. Take a look at this infographic from PatientsLikeMe, which shows how 29,000 people with MS experience their illness and rate their medication.This is new, people-generated knowledge. I was a GP for 25 years, but I had no idea that ‘brain fog’ was one of the commonest symptoms for people with MS. It is only when 29,000 people come together that this kind of knowledge emerges.”

Power to the PeoplePaul Hodgkin on EHI, 2.10.2012 http://www.ehi.co.uk/insight/analysis/962/power-to-the-people.

http://www.wired.com/wiredscience/2012/10/big-data-is-transforming-healthcare/

These data-hungry gadgets also harness “the power of connecting people with their own data and getting them to see how that could change their lives,” said Goetz.

“The crowd-sourced venture capitalizes on humanity’s new

ability to collect, analyze, triangulate and visualize vast

amounts of data, in real time”

“watching the planet develop a nervous

system of data.”

Partnership working

Tailored for patients

The Android app has been downloaded about 100,000 times. Since the launch, 3.3 million visits to kp.org, or about 15% of total visits to the site, have come from mobile devices, according to Kaiser officials. About 3.9 million members, or 63% of all eligible members, are using kp.org, according to Kaiser.

Help make the compelling case for a partnership approach to health,

wellbeing and care…and unlock the vault of information

Language embeds behaviours and attitudes, so please help build a new

dialogue Words Matter to Us

http://www.wordsmattertous.blogspot.co.uk

t.gronlund@nhs.net

cfh.ppi@nhs.net

My challenge to you

myRecord Project

Richard InceProject ManagerAnna BurnsResearch Coordinator

Project insights

Clinicians’ fears of data-sharing with patients

countering those concerns

improve efficiency, safety and improve relationships

Use learning to inform ways of supporting change in primary care

Changing cultures

Clinician referral

Engaged, empowered and informed patients

Available resources

www.myrecord.org.uk (Oct 2012)

richard.ince@nhs.netanna.burns@nhs.net

Thank you

PATIENT FEELINGS ON ELECTRONIC RECORDS ACCESS: BENEFITS AND CHALLENGES

Katie Wilson User Involvement Projects Officer, Diabetes UK

Background

• The myRecord project commissioned Diabetes UK to speak to patients who are in regular contact with GP services – ‘users’ and ‘non-users’

• The aim was to explore the feelings associated with the ability to access their medical records online

Method• Five focus groups

– Greyfriars Surgery, Hereford– St John’s Medical Practice, Lewisham– Diabetes UK

• Semi-structured approach, using the same question framework for all

• Participants were asked to think about;– Good feelings about RA– Difficult feelings about RA– Potential benefits of RA (impact on time, accessibility, quality of

care)

Participants

• We spoke to 12 ‘users’ – range of medical conditions

• We spoke to 26 ‘non-users’ – 16 were people with diabetes

System users

• General enthusiasm – in principle, a good idea– ‘Brilliant’ and ‘excellent’

• But, frustrated by administrative and technical difficulties

• Current difficulties inhibiting full potential

System users – good feelings• Control and empowerment

– the ability to ‘make informed choices’– ‘Ammunition’ to get the care we need

• Trust– No longer being ‘kept in the dark’– ‘Puts you on an equal footing’

• Motivation– Track trends, ‘see the whole picture’ and set clear goals– An ‘incentive’ for improving health management

• Reassurance– ‘holds the information you forget’– Clarification

System users – difficult feelings

• Anxiety – Misinterpretation of information– ‘needless worry’– Lack of detailed information or gaps in the record– Security – divided opinions

• Frustration– ‘Clunky’ system– Errors on records and ‘blocked’ information

System users - benefits

• Saves time and improves efficiency – Reduces stress– Saves ‘effort’ and ‘energy’ and is an ‘instant fix’– ‘Incredibly convenient’

• Added value – Enables preparation for appointments

• Quality of care

Non-users• Initial reactions were fairly mixed

– Some expressed active hostility– Some were indifferent– Some could see the potential benefit, but had

concerns– Some were very positive

• After discussions people were more positive, although still sceptical about security

• Some remained indifferent

Non-users – good feelings• Control and empowerment

– Increased ownership over their healthcare– ‘Greater autonomy and independence’– ‘Information is power’

• Trust – Facilitating an ‘equal partnership’ with HCPs

• Motivation– Care planning and goal setting (especially helpful for the groups

of participants with diabetes)• A right

– ‘I want it because it is mine’

Non-users – difficult feelings• Anxiety – information

– ‘I’d rather not know, what you don’t know won’t hurt you’

– ‘I’m less concerned about the heavier stuff – the GP can keep it to himself’

– Worry that information would lack context and a full explanation

• Anxiety – security– ‘opening the door’ to hackers

Non-users – benefits• Time saving and efficiency

– Accessing information ‘when it suits you’– ‘self service and on demand’

• Improving quality of care– More constructive appointments– Care planning and self management– Increasing knowledge and understanding– Help join up services and improve transparency

Closing comments• Agreement that for the right people, records

access has the potential to be very beneficial• Particularly useful for those with long term

conditions• ‘A practical tool to help you help yourself’• Important to manage expectations

THANK YOU

Even Patients Can Do IT…

18th October 2012

Cartoon taken from www.mediclicks.net

Yvonne M BennettPatient & PPG Secretary of

Haughton Thornley Medical Centre

… but it is not always easy

We live in an age of technology but that doesn’t mean everyone can use it

Some need more help than others but where from We can use IT as a tool to manage our own & family

health Self care doesn’t mean NO care If we suffer from asthma, drug addiction, cancer etc We can be educated in managing the condition by our

healthcare professional There are 8760 hours in a year and we need to look after

ourselves and family for 8756 of those

Patient Perspective

Being an active partner in the doctor/patient relationship

A relationship based on trust Having choices Help the clinician to help me by having all

information available to hand NOW Being a Happy Patient! To do all this we need access to our medical

records

Our Practice Website

www.htmc.co.uk

How do we get access to our records?

What can we do with access

We can order repeat prescriptions We can check previous medications We can check appointments We can also cancel appointments (We could make appointments before)

We can check results We can check x-ray reports We can read letters We can print anything we think may be of use e.g.

medication list, blood results

Photographs

A photo showing an operation scar with a possible infection

A photo showing a leg ulcer This can be monitored to see how the scar is

progressing

The Advantages Doctor/Patient relationship.

Take an active role in your own healthcare together with the doctor

On Holiday Seeing a Consultant in a

hospital outside the area Receiving care in the

community Family members living in

another part of the world Emergency Time – repeat prescriptions,

appointments, results, letters

Disadvantages Forgotten History Bad News Abnormal Results X-rays 3rd Party Information Might not agree or like

with what’s been written about you

Might be feeling worse than before

Problems being solved Children

parent access until 10years and then discussions between child, parent & GP

Nursing Homes Dr Amir Hannan from Haughton Thornley Medical Centres Dr Benjamin

Brown, Sarah Thew, Professor Iain Buchan from this University Established a Local Care Records Board

To deal with any complaints “Grey areas”

3rd party data Foreign-speaking patients Learning difficulties / memory problems Coercion in the home / domestic violence

The Accident - 2011Ambulance & A & E visitPre-op assessment & operationDischarge letter (other services involved)Hydrotherapy and Physiotherapy letters8 Visits to Fracture Clinic

8 Letters8 appointments at GPs8+++ telephone calls

Patient = 11hrs for apptts/40 mins telephone Doctor = 8 apt @ £25 = £200 NHS saving Other Patients benefit from 8 extra appointment

Hidden Cost Everything has a cost Time it takes to give Records Access and

keep the website up-to-date Time, money. This event took time to plan,

set the room and funding to pay for refreshments

Time people have given up to attend and their time to get here

Putting people at the heart of care … NHS thinks patients have no life and a 10 minute

slot with a healthcare worker cost them nothing We may choose to go to a specific hospital but with

‘speciality’ hospitals taking off we may have no choice but to travel far.

Not everyone can claim travel cost This doesn’t always mean they can easily afford it

but they are just above the threshold level This isn’t just money but time as well. A journey

involving 6 busses (3 each way) is no use to anyone feeling ill.

Self care – not NO care!

If you are living with a health condition, or just want to learn how to look after yourself better, visit www.htmc.co.uk and look at the self care section. Remember the website is

Thank you for listening

htmcppg@gmail.com

www.htmc.co.uk

Better Care Better Health Better Life

6 years experience of Haughton Thornley Medical Centres offering patients access

and understanding of records

Dr Amir HannanFull-time General Practitioner, Haughton Thornley Medical CentresMember of the Health Informatics Clinical Advisory Team, NHS NW

Clinical Director for the Patient Access to GP Online Services Advisory Group, NHS Northamir.hannan@nhs.net www.htmc.co.uk

Twitter @amirhannan

Better Care Better Health Better Life

Real-time Digital Medicine

Better Care Better Health Better Life

“If you treat an individual as he is, he will remain how he is. But if you treat him as if he were what he ought to be and could be, he will become what he ought to be and could be.”

Johann Wolfgang von Goethe

Better Care Better Health Better Life

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Type of patient How many have signed up %

Diabetes 162/721 22%

Cancer 60/228 26%

Nursing home 30/30 100%

Pregnant 61/321 19%

Bengali patients 154/1571 10%

Total patients 1941/11924 16%

Haughton Thornley Medical Centres, 30th September 2012

Better Care Better Health Better Life

www.htmc.co.uk

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Number of patients signing up for access to records per month

Num

ber o

f pat

ient

s

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What is neededLearn from the past to plan for the present and the futureLess procrastination, more deliveryDefine requirements – details matterClinical / Managerial engagementPatient engagementMedia engagementPractice-based web portal / smartphone app linked to

national repositoryMoneyPeople and ideas matter so invest in them

Better Care Better Health Better Life

6 step plan

1. Clinical, managerial & patient champions2. Facilitators3. Information needs4. Strategy for starting5. Collaborate and share experience6. Evaluate

NHS North Patient Access to GP Online Services Advisory Group

Better Care Better Health Better Life

Twitter

Better Care Better Health Better Life

Better Care Better Health Better Life

Isn’t it time YOU got access to YOUR records and started using it to improve YOUR health and

enter the world of REAL-TIME DIGITAL MEDICINE ?Dr A Hannan

amir.hannan@nhs.netTwitter @amirhannan