How do patients feel about pharmacist access to their medical records? Christine M Bond Department of General Practice and Primary Care

Historically Doctor’s looked after patients and kept paper records No debate about who had access Patients’ rights to access their medical records not acknowledged

Now there are changes in: Societal attitudes Professional roles and health care delivery Electronic information Statute (Wingfield (2002) Pharm.J. 269:328-31) Data Protection Act European Law of Human Rights Freedom of Information Act Health and Social Care Act

ETP or EDI? ETP-Electronic transmission of prescriptions Community pharmacies to be linked to NHSnet MAS might create new set of pharmacy records New clinical roles for pharmacy could be optimised by access to medical records EDI - electronic data interchange would allow two way transfer of information

Some issues? Should patients be fully informed of all instances of access to their records if it can be defended in their best interests? Is community pharmacist access to patient records really a new function which requires consent? Do patients specifically consent to practice pharmacist access to records? What about secondary care?

Can pharmacists access patient records? New statutes do not preclude pharmacists legal access to patient medical records in the interests of optimising patient care Need to understand public opinion in order to implement access without unnecessary public reaction Anecdote is unhelpful Systematic approach is helpful

Scottish study of attitudes to EDI Postal surveys community pharmacists 74% (n=199) general practitioners 72% (n=196) general public69% (n=715) 95 % had received a prescription at some time Sample broadly reflected population for age, sex and deprivation

What did the public think about ETP ? Electronic transfer of prescription data is a good idea 68% –Benefits: convenience, reduced waiting time at GP, fewer GP visits, less chance of ‘running out’ Preferred direct from GP to pharmacy rather than a smart card, or central database

Sharing information by discussion Happy to discuss with pharmacist: Current Rx medication78% Other current medication69% Previous medication 60% Current medical condition44% Previous medical conditions 38% Test results40% Lifestyle47% Age62% None of their medical records 20% (more older people) Assured privacy had little effect on responses

Sharing information by access to records Happy for pharmacist to access: (discuss) Current medication58% 78% Previous medication 48% 60% Current medical condition39% 44% Previous medical conditions 29% 38% Tests33% 40% Lifestyle35% 47% Age 44% 62% NONE of their medical records 38% 20%

Sharing information with GP Agree to pharmacist informing GP : –of problems with medication62% –non-dispensed items53% –of OTC purchases 45% –about general health46% Would not want any information passed to the GP by the pharmacist28%

Security and Confidentiality Only 10% were ‘very confident’, and 45% ‘quite confident’ that it would be possible to make the system secure All three groups had concerns about protecting patient confidentiality

What underlies these responses? Perception of pharmacist’s role

Medical records and treatment should only be discussed between GP and patient. It is the pharmacist’s job only to hand out medicine prescribed by doctor I think people feel more comfortable discussing medical problems with a doctor whereas I think people would not want to share any problems of a more sensitive nature with a pharmacist I think the pharmacist should not pry too much into medical problems and tests, after all the doctor does that, but the pharmacist could discuss medicines and their effects if any. Pharmacist’s role

I personally have no problems discussing medication, lifestyle etc. as I realise a pharmacist is an expert who may offer me appropriate advice. Privacy to discuss past/present medical records should be absolute

Why is there some resistance to the sharing of information? Perception of pharmacist’s role Pharmacy environment

It is important that personal medical records remain secret…..within the doctor's surgery. Not put on computer for every Tom, Dick and Harry in the chemist's shop to gloat over. Would you want a neighbour who works in a chemist having access to full medical records, it is bad enough that they know what valium or methadone are for.. In most chemists there are at least 2 assistants, I would not want them having access to my medical history. It would be very easy for them to see the information on screen

Why is there some resistance to the sharing of information? Perception of pharmacist’s role Pharmacy environment Pharmacist confidentiality

Can we be assured that pharmacists will be held to some sort of code of confidentiality and if that confidentiality is broken what punishment will be dispensed? I know doctors take the Oath for the confidentiality of their patients but I don't know about the pharmacist

Why is there some resistance to the sharing of information? Perception of pharmacist’s role Pharmacy environment Pharmacist confidentiality Pharmacy staff confidentiality

Are people serving the public in a chemist's shop sworn to secrecy? The confidentiality most patients expect may be compromised if pharmacy "staff" in general could access the pharmacist's data From past experience of shop assistants, I don't have a lot of faith in their tactfulness and confidentiality.

Why is there some resistance to the sharing of information? Perception of pharmacist’s role Pharmacy environment Pharmacist confidentiality Pharmacy staff confidentiality Security of the system

How comfortable will people be with personal medical records available on line and predisposed to unauthorised access? The security aspect is a worry, with hackers gaining access to confidential information? The computer system would have to be made secure as it could be open to abuse

So what does this mean? Pharmacists and GPs are not seen as part of an integrated NHS but as two separate services –Patients think pharmacists only need to know about their medicines –Patients don’t want GPs to know about their use of other pharmacy services Patients are not very confident that the system could be made secure We need to address these issues so both legality and acceptabilty of access to records is OK We should not be deterred by some expressed anxieties but be empowered by them

What should we do? Education for patients on rationale of new roles for pharmacists Professionalism of pharmacy to be highlighted Role of dispensers and counter assistants must also be transparent and professional Patients may have a cultural right to ‘control’ access to their own medical data (courtesy) GPs may be best placed to obtain ‘consent’ Safeguards to protect patient information must be put in place (encryption)

Acknowledgements Collaborators: Terry Porteous, Phil Hannaford, Roma Robertson, Ehud Reiter The project (Electronic Data Interchange: Identifying the requirements of stakeholders) was funded by SPGC Research Trust Porteous, T., Bond, C., Robertson, R, Hannaford, P,., Reiter, E. Electronic transfer of prescription related information: comparing the views of patients, GPs and pharmacists. Br. J. Gen. Prac. 2003;53:204-9