Unintended consequences of patient online access to health records: a qualitative study in UK primary care

Andrew Turner; Rebecca Morris; Lorraine McDonagh; Fiona Hamilton; Sarah Blake; Michelle Farr; Fiona Stevenson; Jon Banks; Helen Atherton; Dylan Rakhra; Gemma Lasseter; Gene Feder; Sue Ziebland; Emma Hyde; John Powell; Jeremy Horwood

doi:10.3399/BJGP.2021.0720

Unintended consequences of patient online access to health records: a qualitative study in UK primary care

Br J Gen Pract. 2022 Dec 21;73(726):e67-e74. doi: 10.3399/BJGP.2021.0720. Print 2023 Jan.

Authors

Affiliations

¹ National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol and Weston NHS Foundation Trust, Bristol; Centre for Academic Primary Care (CAPC), University of Bristol, Bristol Medical School, Bristol.
² NIHR Greater Manchester Patient Safety Translational Research Centre, Centre for Primary Care, University of Manchester, Manchester.
³ Research Department of Primary Care and Population Health, University College London, London.
⁴ University of Bristol, Bristol.
⁵ Unit of Academic Primary Care, University of Warwick, Coventry.
⁶ Department of Philosophy/School of Oral and Dental Sciences, University of Bristol, Bristol.
⁷ Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol.
⁸ Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
⁹ School of Sociology and Social Policy, University of Leeds, Leeds.

Abstract

Background: Health systems are seeking to harness digital tools to promote patient autonomy and increase the efficiency of care worldwide. The NHS Long Term Plan created the right for patients to access 'digital first' primary care by 2023-2024, including online patient access to full medical records.

Aim: To identify and understand the unintended consequences of online patient access to medical records.

Design and setting: Qualitative interview study in 10 general practices in South West and North West England.

Method: Semi-structured individual interviews with 13 patients and 16 general practice staff with experience of patient online access to health records.

Results: Online access generated unintended consequences that negatively impacted patients' understanding of their health care, with patients finding surprising or difficult to interpret information. Online access impacted GPs' documentation practices, such as when GPs pre-emptively attempted to minimise potential misunderstandings to aid patient understanding of their health care. In other cases, this negatively impacted the quality of the records and patient safety when GPs avoided documenting speculations or concerns. Contrary to assumptions that workload would be reduced, online access introduced extra work, such as managing and monitoring access, and taking measures to prevent possible harm to patients.

Conclusion: The unintended consequences described by both staff and patients show that, to achieve the intended consequences set out in NHS policy, additional work is necessary to prepare records for sharing and to prepare patients about what to expect. It is crucial that practices are adequately supported and resourced to manage the unintended consequences of online access, now that it is the default position. A table of potential unintended consequences and mitigation measures is provided to aid practice managers and clinicians implementing online access.

Keywords: digital first primary care; digital health; electronic health records; general practice; primary health care; qualitative interviews.

MeSH terms

England
General Practice*
General Practitioners*
Humans
Primary Health Care
Qualitative Research