1. Getting Started with Records Access Patient Access to Records and Transactional Services Becky Gayler and Isabella Davis-Fernandez Health Informatics Team

2. This guide is for practices It is intended to help you: 1.Plan your approach 2.Put new processes in place 3.Communicate with patients 4.Get the most from your system 5.Evaluate how well things have gone

3. Firstly, why are we doing it? Empowering people to better manage their health and care Delivering transparency to improve quality of care and patient experience Integrating and personalising care packages Supporting better patient / clinician decisions to improve quality, safety and effectiveness of services Making better use of resources

4. Online DES Details published March 2013 The payment for participating GP practices will comprise three components, each representing a third of the investment available for this enhanced service in the 2013/14 financial year: Component 1: A single payment of £0.14 per registered patient, which represents a payment of £985 for an average-sized GP practice (registered population 6,911) based on satisfactory evidence of enabling and utilisation of online booking; and, Component 2: A further single payment of £0.14 per registered patient, which represents a payment of £985 for an average-sized GP practice (registered population 6,911) based on satisfactory evidence of enabling and utilisation of online repeat prescribing; and, Component 3: A flat rate payment of £985 to each GP practice based on satisfactory evidence of a proportion of registered patients being issued with passwords for accessing services online.

5. Useful background reading For Patients / PPGs – It’s your record: A guide to accessing records online It’s your record: A guide to accessing records online – Keeping your online health and social care records safe and secure Keeping your online health and social care records safe and secure For Clinicians – RCGP Patient Online Roadmap RCGP Patient Online Roadmap – RCGP Records Access Guidance for GPs RCGP Records Access Guidance for GPs – RCN Personal Health Records and Information Management RCN Personal Health Records and Information Management Everyone – myRecord project myRecord project – Cropredy Surgery, Patient Access web-page Cropredy Surgery, Patient Access web-page – NHS North West Practice Toolkit Available on NHS Networks: Patient Access to Records and Transactional ServicesAvailable on NHS Networks: Patient Access to Records and Transactional Services – Department of Health Summary of Patient Online Resources

6. Things to consider Who will have Access? Will the practice pilot first, who should be involved? Should Access be by invitation or open? Are there special considerations for particular patient groups? (e.g. patients with Mental Health problems) Should parents be given access to their child's record? Up to what age? Should children be given their own access? If so when? Should carers (other care providers e.g. nursing homes staff) be given access? Should patients be encouraged / discouraged to share access with family / friends / other providers? Should GPs check records before access is given?

7. Things to consider What will patients see? Should patient see free text entries? How do we ensure that patients do not see 3rd Party data? What happens if patients see bad news or unexpected information on their record? Does practice need to consider making any changes to why records are maintained? How can the practices avoid serious test results being viewed online before the patient has been contacted?

8. Things to Consider How to handle queries? What happens if Patient sees information concerning another patient which has been misfiled? What should happen if Patient sees an error on their record ? What should happen if Patient has a query about the clinical content of the record?

9. Things to consider Who do we need to inform? Patients PPG Practice staff Health Professional who may contribute to the record CCG

10. Things to consider Useful guidance: RCGP Patient Online IG Risk Register RCGP Enabling Patient Access Supplier User / Training Documents which detail how to configure systems. Good practice example protocol:

11. Set-up costs 1. Practice Engagement, Planning and Training – Agree practice implementation approach and plan – Staff time to attend training – External (system supplier) trainer costs 2. Supplier costs – subscription for online services (InPS only) 3. Patient awareness and communications – Web-site setup and maintenance – Patient communications materials (e.g. leaflets, forms etc.) design and printing 4. Admin processes setup – Reorganise appointment books – Configure system for appointments and repeats – Configure free text viewing (records access)

12. On-going work required 1. Admin process on-going – Maintain online appointments – Check workflow for repeat requests / online messages – Audit uptake and use of online system 2. Register patients for online services – Agree and set up new processes to register patients for VOS – Carry out patient ID checks and issue login credentials 3. Support for patients and carers – Support patients to use records as part of clinical care – Deal with patient queries about registration or login processes – Deal with patient queries about record or clinical issues arising from records access

13. How might efficiency be improved? Each Appointment booked online has potential to save 3-4 minutes admin time = approx 50p-66p Each Repeat request received online has potential to save 5-6mins admin time = approx 83p- £1 After 12 months, practice of 10,000, with 30% patients signed up; 250 appointments booked / cancelled *=£330 p.m 350 repeat requests =£460 p.m

14. Patient benefits from transactional services….. Fewer patients kept waiting on hold. Commuters and parents have better access to appointments. Patients can order scripts at any time. Increases patient choice of available appointment times Patients provide information when they book online which helps GP prepare for the consultation and saves time. Reduces DNAs - where patients previously found it difficult to get through on telephone to cancel appointments. Frees up phone access for patients who are not using online services. Replaces email repeat requests (grown dramatically recently) with safer, more secure, more efficient process. Reduces medication wastage by enabling patient to order directly rather than via community pharmacist. Administrative savings as processing less paper. Secure messaging replaces cumbersome and insecure email repeat requests

15. Patient benefits from Records Access Improves trust and communication Increases patient ownership of care / treatment plans Compliments other initiatives advanced care plan registers, SCR and EPS2. Potential to support patients with long term conditions with decisions about their care, sharing records and information with other agencies (e.g. social care) and supporting improved compliance with treatment plans Support for carers of patients with dementia, and children with complex / long term conditions. Improved patient safety. Correct medication is automatically selected for practice staff to process. More effective consultations. Improves patient experience

16. Typical “To do List” (Part 1) Task no. Weeks before Access What needs to be done?Comments 16Agree scope of online services and practice approach This task is likely to be on-going as practice work towards implementation. Scope will need to be revied after training / further discussion with patients and staff. 26Identify practice clinical champion, practice implementation lead. What role will Patient Participation Group have in agreeing processes and materials for patients? 35 Practice meeting / training session to provide an overview of what involved and the practice approach 45Log a call with System Supplier to let them know when you plan to enable Access 54System supplier training Need to contact CCG / Supplier to arrange. System supplier training wil l ensure that your system is enabled and configured the way the practice wants to use it. This training will help inform the development of other practice processes, but may need to be refreshed when Access goes live. Ensure practice lead can train other staff and has copies of all supplier training materials. Most of these will be available online. If possible set up a dummy patient.

17. Typical “to do list” (Part 2) Task no. Weeks before What needs to be done? Comments 64Develop process for registering patients. Consider whether / how GPs will approve / check patient applications. Consider whether the registration letter is to be picked up in person, or whether it can be emailed if patient ID has been previously checked. Registration details should not be emailed to an address unless the patient has confirmed in person that it is their personal address and they are happy for it to be used for login details. 74Agree patient registration letter and login instructions Include information on who to contact for help about registration / technical issues and what to do if there are issues with their record. Let patients know that the system is backed up overnight and occasionally they may not be able to log on for a short while. 83Agree Patient Consent forms There are separate consent forms for Transactional Services and Records Access. The Record Access consent form should include information about the risks and responsibilities involved in accessing records. Consider whether a separate form is needed for patients and carers. Consider adding a consent box to allow you to contact the patients about their experiences with records access. 93Inform other clinicians outside the practice that patients will have access Don't forget to include community nurses in discussions. Consider putting a notice at the bottom of referral letters to raise awarenss with secondary care.

18. Typical “to do list” (Part 3) Task no. Weeks before Access What needs to be done?Comments 103Consider any changes to record-keeping protocols Consider whether test results / correspondence will be filed before the patient has been contacted directly to discuss. Are letters normally filed before or after the GP sees them? 112Agree and produce patient information materials Printed forms, leaflets, posters, changes to website etc. 121Recruit / invite patients and publicise access Send out invitation letters, include in new patient packs. 130Recap system training and brief staff on new processes Have a simpified flow chart available and FAQ sheets for staff to refer to. 140Start registering patients Suggest Read coding all patients using the system to make it easier to identify them. 15Start monitoring uptake of service, benefits / dis- benefits and resource requirements Use patient survey (if you have obtained patients permission and email address with the consent form). Include as standing item on practice team meetings. Report progress to Patient Participation Group and continue to consult with PPG over any improvements / changes to the process.

19. Informing Patients Example materials are included below which can be adapted to suit your local style / approach. Information Leaflets – Transactional Services only – Records Access Text from these leaflets can also be used on: Web-pages Messages on repeat request forms Invitations for Chronic Disease reviews Includes in new Patient Packs

20. Obtaining Consent Patients need to know about the risks and responsibilities involved in having online access. Practices need to: obtain consent ensure patient ID is checked ensure correct email and mobile numbers are held ensure parent / carer relationship is validated where access is being given to 3 rd party

21. Example Consent Forms Example materials are included below which should be adapted to suite the practice approach. Transactional services only – Patients Form – Parent /Carers Form Records Access – Patient Form – Parents Form – Carers Form

22. Introducing new ways of working Example practice protocol which covers both Transactional Services and Records Access Example flow diagram setting out process for setting up a patient with Records Access FAQs for Practice Staff

23. Abnormal Test Results Do GPs see all the tests results before they are filed to the record (and available online)? If comment added “abnormal - make an appointment”, how is patient contacted? Sometimes if won’t be possible to contact the patient. Has the information in the consent form made them aware this could happen?

24. Getting the most from your system Arrange for face to face training from supplier / CSU / CCG. Enable, configure and test system before using it with live patients. Where possible set up a test patient. Recap on training just before registering first patient. Ensure all problems are logged with system supplier. Request system enhancement, share hints and tips and known issues via User Groups. Ask supplier for patient facing material e.g. posters, flyers etc.

25. Hints and Tips (Registration) Online services take time to catch on. Need proactive promotion. On consent form inform patients their email address will be used by the practice to send confirmations of appointments and cancellations. Think about obtaining consent for text messaging where used. Verify the patients identity in person before you give them their credentials. Use tick box on the consent form to show that ID has been checked and form scanned on the record Sign-post patients to online help on Patient Access / VOS / SystmOnline. Use Read codes recording the following: 9RN id verified, 9NDP consent for sms or 9NDS consent for email Set a reminder on chidren’s records to review parental access. Ensure mobile numbers for teenagers are checked as many originally have parent’s numbers recorded.

26. Hints and Tips (Transactional Services) Enable as many routine GP bookable slots as possible as this will give the patient more choice and encourage further online booking. Allow at least 2 appointments to be bookable at any one time, so that patients can have a nurse and GP bookable at the same time. To allow nurse appointments to be booked on line, practices could consider setting up clinics by type e.g. cervical screening, flu etc (but this would only work for bigger practices.) Make sure repeat medications are authorised when last issue is processed so they continue to appear as available to order online.

27. Providing Help for Patients What information do patients need to help them log on and use the system successfully? The following log in instructions have been developed for EMIS Patient Access: Transactional Services Records Access Quick guides for patients, practice examples:

28. Evaluating how things are going Monitor which patients who have registered but not successfully activated their account. Audit level of appointment booking / repeats requests. To estimate “practice efficiency savings” consider Monitor resources required to implement / operate Access Monitor impact on telephone calls, DNAs, and turnaround time for repeat requests. Collect baseline information before online services start. Log patient queries / complaints about system or record content Use patient questionnaire and or discuss with PPG / focus group to gather feedback Example audit sheet which can be adapted to collect and analyse information