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Medical records

Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
These days they're computerised. GPs and nurses have access at a click of a mouse to your entire life's medical history. Big brother State- what when it comes to applying for jobs and declaring on medical form and taking life/critical illness insurance. Do you worry about who has access to your medical details and anyone applied to inspect their records at the GP?

Comments

  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    I booked to see my nurse to save bothering my GP once. Instead of asking about the purpose of my visit she looked at her screen and bombarded me with awkward questions about a health issue 24 years ago. Don't trust her- straight to GP next time and avoid her- badly trained or new to job
  • **helen****helen** Mod malarkist Posts: 9,235 Listening Ear
    This is a really interesting question - think it's probably more one for P&D though, so hope you don't mind me moving it there. :)

    On topic - not sure if you've come across this website before?

    http://www.patientopinion.org.uk/
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    I don't have an issue because I know who can access my records and why they would do so. There's a myth out there that the computerised records means that anyone working in the NHS can view your history. Well, I can't and I hold a pretty senior position. Any information sent to me has all the information which would identify any individual removed.

    When it comes to applying for life/health insurance then you have to give permission for them to access your information, Of course, failing to do so would mean they refuse to offer a policy (in most cases) but then what do you expect, they need to assess the risk

    As for the nurse asking about medical history, that would depend on what that condition was. It certainly wouldn't surprise me, given the requirements on GP practices to maintain full medical history, ensure that they are treating any condition correctly and monitoring for relapses etc. These are requirements of their contract.

    It may seem weird that they ask about weight, or blood pressure, when you go in for a sore throat (for example) but there is a reason for that.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    Having computerised records seems sensible. paper records are just as "at risk" as computer ones, people seem to think records being looked at without authorisation is a new thing. It's a LOT harder to get away with, everything on a computer is audited. Who looked at your file, how long they looked at it, did they print it/email/copy to USB? It's all recorded.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    Whowhere wrote: »
    Having computerised records seems sensible. paper records are just as "at risk" as computer ones, people seem to think records being looked at without authorisation is a new thing. It's a LOT harder to get away with, everything on a computer is audited. Who looked at your file, how long they looked at it, did they print it/email/copy to USB? It's all recorded.

    Thing is no one knows activity of staff unless things go wrong and there is investigation by management
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru

    When it comes to applying for life/health insurance then you have to give permission for them to access your information, Of course, failing to do so would mean they refuse to offer a policy (in most cases) but then what do you expect, they need to assess the risk

    In other words, want their insurance product, can't say no.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    KiwiFruit wrote: »
    Thing is no one knows activity of staff unless things go wrong and there is investigation by management



    Depends on the organisation. I know we are randomly audited, I know certain files have flags attached to them if anyone looks at them. I know the NHS is similar.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    Even without people setting out to look at files deliberately - electronic records still show more to anyone searching than the paper copies used to.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    KiwiFruit wrote: »
    Thing is no one knows activity of staff unless things go wrong and there is investigation by management

    Or access is blocked from the start, which is what happens with NHS Smart Card.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    KiwiFruit wrote: »
    In other words, want their insurance product, can't say no.

    And that's an issue because....?
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    So what does NHS smart card do?
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    So what does NHS smart card do?

    It gives access to the central NHS database (you know, the one that the media say isn't there!) but with different levels of access. So depending on your role you can have information which identifies individuals or like me just get population information (i.e. how many knee replacements for patients in my area)...
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    But there are an awful lot of people with access to individual patient records.

    Work in a profession that might need to view an x ray? In which case, you can search and view the x rays/imaging results for any patient. Etc.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    But there are an awful lot of people with access to individual patient records.

    Work in a profession that might need to view an x ray? In which case, you can search and view the x rays/imaging results for any patient. Etc.

    Remembering that, it each of those professions, you are bound by ethics as well as confidentiality issues. It always surprises me that people are so concerned about electronic security. Put something in the post, rather than email, as it's actually a lot more risky. Put medical records on IT systems and they are actually much safer than the old paper versions.

    Much concern about your hospital records and x-rays etc, yet no-one is disconcerted by the records maintained by your GP - even though those records are much more comprehensive.

    And this coming from someone who doesn't trust the Govt with any information about himself!
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    Even without people setting out to look at files deliberately - electronic records still show more to anyone searching than the paper copies used to.



    It all depends on your credentials. My logon ID at work only lets me look at certain things. Any attempted access to something I shouldn't be looking at is blocked and recorded. Any checks I do on people are audited (I know because I was asked about one 3 months later). It is exactly the same for the NHS.

    As I said before, there is a myth that electronic records are inherently less secure than paper ones. They aren't. Much easier to sneak into a paper records store, nick a record, photocopy and return it than it is to logon to a terminal and look at it online. And the other difference is, with a paper record nobody would ever know you were there.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    It's more the confidentiality that concerns me with electronic records - and without people necessarily setting out to look for stuff.

    Take an example.

    A doctor goes on a training course on how to use the electronic records system to view digital X rays. As part of the training, they're prompted to have a go using the search function - either for a recent patient, or using their own surname. Doctor then gets a list of up all potentially relevant records the search has found, including an ultra sound report for one of their family.

    Bye bye all medical confidentiality to that family member.

    Now, that's not someone deliberately setting out to look up info they shouldn't - that's just the way electronic systems work when you search them. With a paper system, it's much harder to accidentally stumble over things you shouldn't.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    We use dummy systems for training.

    But even in a live, paper based system, you can still get the wrong notes. Badly filed notes, pages missing, falling out. Information in the wrong folder. In fact that was the cause of many clinical errors - same named patient but not the correct set of notes.

    There is no totally failsafe system, it's simply not possible. What we have now is much safer than what we had before.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    What we have now is much safer than what we had before.

    Getting people to believe it is like pissing in the wind. For a lot of people as soon as you mention computer they picture hackers sat in darkened room or sinister types plugging USB sticks into the terminals and copying everything.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    We use dummy systems for training.

    Who's 'We'.

    The above example wasn't a hypothetical scenario - it was a slightly adjusted version of actual incident.

    I'm not against electronic systems entirely - am just very wary of the unrealistic promises being made about electronic medical records, particularly around confidentiality. In many ways one of the great benefits of the system is that it provides easier, more accurate access to patients medical records. The down side, is that is provides easier, more accurate access to patients records.

    You takes you pick, but the sacrifice that's being made for the benefit is somewhat being swept under the carpet.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    Who's 'We'.

    As in NHS, certainly that's how I've always been trained
    I'm not against electronic systems entirely - am just very wary of the unrealistic promises being made about electronic medical records, particularly around confidentiality. In many ways one of the great benefits of the system is that it provides easier, more accurate access to patients medical records. The down side, is that is provides easier, more accurate access to patients records.

    You takes you pick, but the sacrifice that's being made for the benefit is somewhat being swept under the carpet.

    I think that the real issue here is the fact that change means that people look at the new system and seek out it's faults rather than look at the current system and look for faults in that.

    Paper systems are awful. So full of holes and risks that if I suggested changing from electronic to paper then people would go totally apeshit. Notes left in clinicians cars overnight, lost after put on the car roof whilst the clinicians sorted their gear out and then just drove off. Notes transferred from site to site by courier but lost on the way. I've seen medical records posted sent to a local pub rather than the GP surgery. Test results placed in the wrong notes, on drugs written into the wrong notes - both ending in medical negligence claims. All of those examples very real and each resulting in Serious Incident Reviews that i've been involved in.

    Paper systems are flawed. IT systems are too, in fact if you look at the faults of one you can usually get the same fault in the other, just in a slightly different way. The difference is that the benefits of a universally accessed medical record outweigh those faults. IMHO.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    Not necessarily going to argue that paper records are better - just that the flaws are being seriously masked. Your attitude possibly being a good example of the excellent proganda going around. Benefits may outweigh the downsides to some, but there are definite downsides.

    This was also NHS training, and seems pretty standard in the area.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    I'm not sure what the problem with computer records are?

    Also, there was once a group of people that thought farming machinery would be the end of us all, ahh yes the luddites.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    The problem with computer records, is that they significantly reduce medical confidentiality - and no one is being told about it.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    The problem with computer records, is that they significantly reduce medical confidentiality - and no one is being told about it.

    I really don't see how though. When I worked at the hospital I could request anyone's records at any time from anywhere. It might take a couple of days to get to me but they'd still arrive.
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    The problem with computer records, is that they significantly reduce medical confidentiality - and no one is being told about it.

    How exactly? The only thing stopping you reading a paper file is a cabinet that MIGHT be locked. There's nothing stopping you taking it, nothing stopping you copying it and nothing stopping you distributing it.
    I have it on good authority that everytime someone at our work uses "print screen", or any of the other methods of copying, it is recorded. Everything we do is audited in minute detail. I am physically unable to see if a file exists, let alone access it if that file is restricted above my pay grade, if I do somehow stumble across a restricted file and try and open it I get a massive popup window informing me my attempted access has been monitored and recorded and I know, somewhere, someone has received a flash message saying I tried to read it.

    Please explain for me, how that is less secure than a traditional paper filing system.....
  • Former MemberFormer Member Posts: 1,876,324 The Mix Honorary Guru
    It depends how you measure things, which is the most secure. I am sure there are more potential and actual security breaches with paper. However electronic ones can be much bigger - how much more information can be held electroonically on a missing laptop or a key stick than can be held in a briefcase or a bundle of papers?

    Which doesn't mean that we shouldn't use electronic; it does mean that their needs to be a step change in the way we handle data

    (Though it can be taken to extreme's - someone once refused to send me a list of the Chief Executives of local authorities in England, with their work e-mail addresses - because that could fall under data-protection, meaning two members of my team had to spend a day compiling the list by ringing up the individual authorities)
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