Patient Online Access – A Guide For Primary Care

Patients can now access and transact with their practice online using a variety of web-based applications. It allows the patient to transact with their Practice online at a time convenient to them.

Current functionality for patients through online applications such as the NHS App allow patients to transact with:

• Appointments to be booked or cancelled online
• Repeat Prescription Requests
• Medical Record online access

It is also important for practices to be aware that:

• Sensitive information may be hidden from the patient’s view. This can either be done when the consultation is written up, or later when reviewing the notes. Details for EMIS Web here
• Access to the medical record can be enabled for documents and consultations from a certain date. This makes it much safer in respect of inappropriate access to, say third party information.

The BMA GP contractual commitment is that, patients should be offered, and on request be able to access, prospective record access including free text consultation notes and documents ie hospital discharge letters, referral letters etc.

There are benefits from allowing access to the medical record and these include:

• Patients have access to their problem list as well as medications that they can share freely to help manage their health. This is particularly beneficial for patients who have long term conditions
• When blood tests or investigations are requested, patients can obtain the result, along with a comment from their GP, without having to contact the GP practice
• Document access will allow patients to share in the letters sent to and from the hospital
• Allowing access to the medical record will help reduce access for Subject Access Requests under GDPR
• Access to immunisations will enable patients to know what they have had previously
• One study showed that if 30% of your patients have FULL record access and use it at least twice a year, a practice is likely to save 10% of appointments and 100s of telephone calls. Link to reference.

There are global settings that need to be configured at an organisational level and these can then be further adjusted for each individual patient as required. This includes, for example, switching on GP comments for test results.

These recommendations apply to patients over the age of 16. Under 16s can also be granted personal access if they are deemed to be Gillick competent by their clinician. If a patient under the age of 16 is given their own access, it is recommended that a code is applied to the patients medical records:
EMISNQCO278  (Competent to consent to online access)

Online Access
When hovering over the icon in the patient precis bar, you can see the online status of the active patient

The colour of the icon signifies:
Green = Live (fully registered)
Amber = Inactive or Active (not activated access)
Black = Not registered

Proxy Access
Proxy access has also been developed further and further details are available on this from system suppliers. The details for EMIS are available here.

To note – patients with proxies allocated will be identified in the patient precis bar:

For children, proxy access is restricted at age 11 (to book one appointment) and then revoked at age 16.

Recommended Approach for GP Practices within North East London (NEL) CCG

Practice Processes
Practices should be able to register a test patient for online accesses and to ensure that all practice staff are aware of how the services are available and shown to patients online. This could be done within a practice staff meeting for example.

Staff should also be encouraged to register for online access at their own GP practices and to share learning of what they feel works well and what could be improved as a way to improve patient experience.

Once logged in with a test patients as a minimum the following should be reviewed:

• View medications
• See how repeat prescriptions are ordered
• Review which appointments are being shown – and how they are displayed
• Which investigations are viewable
• Are consultations viewable – and how back they are viewable.

This may, for example, lead to the practice reviewing how they want to configure their appointment offering for patients. There is also the option of configuring the clinical system for messages to be displayed informing the patients of practice processes for medication requests or booking appointments.

Practices may want to restrict the access of consultations, free text etc to only be viewed from a certain date in time so that they are confident that robust processes are in place for good information governance within the practice. This can be configured from the online access global settings.

Patient Processes
To increase patient uptake, the process to obtain online codes for detailed medical record access should be made simpler for patients as well as reduce administrative burden for practices. A common administrative burden that practices have is that they do not release access until notes are reviewed in case something needs to be redacted or withheld. In the vast majority of cases, access is granted to patients without any redaction.

To improve the process the recommendation is that patients are given access at the point of request and verification and a clinical review of the notes occurs later, thereby reducing the number of steps in the process.

A step by step process recommended for practices to facilitate access to online services is as follows:

1. Patient requests Online Access
2. Practice issues patient with access information and an application form to complete (see attached)
3. Patient completes and returns application form and practice will verify the identity of the patient
4. A code “91B” (Patient registration data verified) should be added to the medical record
5. Patients are given full access as per the request on their application form at the point of verification
6. The practice will then review the records within a set time period (aiming for 2 weeks) and it is recommended that this is also an opportunity for clinicians to tidy up the medical record to ensure:
   • The problem list is accurate with significant, active and minor problems accurately coded
   • Medications are appropriate and repeat medications are correctly listed and linked
   • Any data deemed confidential is marked as such