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The race to get the NHS online

Internet access to records and electronic appointment booking are goals of a patient-empowered NHS. Sean Riddell looks at how they can be achieved

Like it or not, the internet has revolutionised our lives, and the world is changing at a furious pace, as we increasingly shop, bank, learn and socialise online. The NHS needs to catch up - not just because the Department of Health says so but because it is essential in the drive to deliver better care.

We are the self-service generation, demanding the right to interact with our health services online. Fast-moving technology is providing ever more ways for us to do so, with 45 per cent of the UK population now visiting the internet via apps from mobile phones.

As part of its drive to empower patients, the DH in England has set a target of online access to medical records for all by 2015. It also requires GP practices to offer online appointment booking and email access.

Can we achieve this in less than three years for the whole country? The good news is that a growing number of GP clinical systems are enabling online services. Some practices already offer patients online repeat prescription ordering and appointment booking. However, many more practices remain to be convinced of the benefits. 

What matters most to patients? While records access is the focus of the debate about online services, research shows this is not patients’ top concern. A 2011 survey of 1,700 patients by patient.co.uk showed the highest demand was for transactional services; 87 per cent of patients said they would use an online service to order repeat prescriptions and 85 per cent wanted to book GP appointments online. Nearly half of patients surveyed (47 per cent) were over 55 - showing the demand for internet-based health services is not age-limited.

Similar percentages of GPs supported online transactional services for their patients, too. But while 78 per cent of patients wanted to see their medical record online, only 40 per cent of GPs supported this. It is clear that online medical record access remains a conceptual leap for many.

What are the barriers?

GPs are the most IT-savvy of all health professionals and some forward-thinking practices have offered online patient services for nearly 10 years. They are evangelical about the benefits, which include saving time and money through reduced phone calls and visits to the surgery, and improved self-care among patients. Yet there remain real concerns among practices that have not yet taken the plunge.

In my view, there are three main barriers to universal adoption.

The first is the fear of loss of control of the practice’s appointment booking and repeat prescriptions systems, and abuse by patients. In reality, practices have found that putting the patient in the driving seat makes them more responsible and ensures they are more likely to attend appointments or obtain repeat medication on time.

The second is GP attitude - “my patients won’t use it”. This is increasingly unlikely in a world where 86 per cent of silver surfers regularly shop online. Practices offering online services report users across the age spectrum.

However, as experience with HealthSpace showed, ease of use is paramount if you want to get patients on board. This covers everything from intuitive registration to logging on and using the system day to day, while ensuring it remains secure. Further streamlining of online services by system providers - for example, making registration much easier for the patient, and taking the onus away from the practice for providing new or lost passwords - will be vital to ensure mass take-up. 

The third barrier is patient education and confidentiality - this is vitally important around records access, and should not be underestimated. There are real fears that others may be able to access sensitive information via shared home computers, or that a patient may see an important test result before the GP can discuss it with them.

The current emphasis on records access is exacerbating confidentiality concerns among health professionals. It is assumed that patients will be able to view their entire medical record. While I admire the pioneering work done in this field, I believe it misjudges what the majority of patients want - timely access to relevant information about their health.

Disease-specific views of a patient’s record - for example, showing diabetic patients their HbA1c score as part of a diabetic summary that includes explanations of results - may be more useful to the patient and more acceptable to busy GPs.

The future                                                                                                    

Introducing transactional services is just the first step. Some forward-thinking GPs are using online consultations and monitoring for long-term conditions such as asthma, diabetes and hypertension. Patients are working in partnership with their GP to closely monitor their condition, only visiting the surgery when there’s a real need.

Health apps will grow exponentially; the logical next step is one that allows you to book appointments, order prescriptions and check your blood pressure at the touch of a button. It’s coming soon to a smartphone near you.                

Sean Riddell is chief executive of EMIS Group.

Readers' comments (1)

  • A very interesting article. I believe it is not just patients who assume they would be able to access their ENTIRE medical record.
    Their should be a clear national minimum standard of what should be online. If we agree what that minimum is, we might find clinicians happier to come on board.

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