How do patients feel about pharmacist access to their medical records

1
How do patients feel about pharmacist access to
their medical records?

• Christine M Bond
• Department of General Practice and Primary Care

2
Historically

• Doctors looked after patients and kept paper
  records
• No debate about who had access
• Patients rights to access their medical records
  not acknowledged

3
Now there are changes in

• Societal attitudes
• Professional roles and health care delivery
• Electronic information
• Statute (Wingfield (2002) Pharm.J. 269328-31)
• Data Protection Act
• European Law of Human Rights
• Freedom of Information Act
• Health and Social Care Act

4
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

5
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?

6
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

7
Scottish study of attitudes to EDI

• Postal surveys
• community pharmacists 74 (n199)
• general practitioners 72 (n196)
• general public 69 (n715)
• 95 had received a prescription at some
  time
• Sample broadly reflected population for age,
  sex and deprivation

8
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

9
Sharing information by discussion

• Happy to discuss with pharmacist
• Current Rx medication 78
• Other current medication 69
• Previous medication 60
• Current medical condition 44
• Previous medical conditions 38
• Test results 40
• Lifestyle 47
• Age 62
• None of their medical records 20 (more older
  people)
• Assured privacy had little effect on responses

10
Sharing information by access to records

• Happy for pharmacist to access
  (discuss)
• Current medication 58 78
• Previous medication 48 60
• Current medical condition 39 44
• Previous medical conditions 29 38
• Tests 33 40
• Lifestyle 35 47
• Age 44 62
• NONE of their medical records 38 20

11
Sharing information with GP

• Agree to pharmacist informing GP
• of problems with medication 62
• non-dispensed items 53
• of OTC purchases 45
• about general health 46
• Would not want any information passed to the GP
  by the pharmacist 28

12
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

13
What underlies these responses?

• Perception of pharmacists role

14
Pharmacists role
Medical records and treatment should only be
discussed between GP and patient. It is the
pharmacists 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.
15
Pharmacists 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
16
Why is there some resistance to the sharing of
information?

• Perception of pharmacists role
• Pharmacy environment

17
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
18
Why is there some resistance to the sharing of
information?

• Perception of pharmacists role
• Pharmacy environment
• Pharmacist confidentiality

19
Pharmacist confidentiality
I know doctors take the Oath for the
confidentiality of their patients but I don't
know about the pharmacist
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?
20
Why is there some resistance to the sharing of
information?

• Perception of pharmacists role
• Pharmacy environment
• Pharmacist confidentiality
• Pharmacy staff confidentiality

21
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.
22
Why is there some resistance to the sharing of
information?

• Perception of pharmacists role
• Pharmacy environment
• Pharmacist confidentiality
• Pharmacy staff confidentiality
• Security of the system

23
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
24
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 dont 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

25
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 informationmust be
  put in place (encryption)

26
AcknowledgementsCollaborators Terry
Porteous, Phil Hannaford, Roma Robertson, Ehud
Reiter The project (Electronic Data
InterchangeIdentifying 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. 200353204-9