Ara Darzi: Workload fears over online patient records

AA Lord Darzi-9991364 Head ShotEngland was the first country in the world to enable patients to book GP appointments, order prescriptions, and access their medical records online 

Since April 2016, all practices have been required to give patients online access to a summary of their medical history, including information on drugs they are taking, the illnesses, allergies, immunisations, and test results.

By March 2018, the aim is to give patients full access to their GP and hospital record. For the first time patients will be on an equal footing with their doctors.

The medical record has always been vital for providing effective treatment, and the NHS has 60m of them. Linked with those records are, of course, 60m individuals who have the best possible reason for learning what is in them. The benefit of bringing the two together has been slow to dawn. At last, the NHS is beginning to realise it.

Just as digital technology has changed the way we bank and shop, it is already changing the way we access healthcare. Enabling patients to see their records, book appointments and order repeat prescriptions online is making services more convenient, personal, and efficient, and giving patients more control.

That is the upside. But barriers remain. As online access grows, greater efforts will be needed to support those without computer skills or with poor health literacy.

Making records available does not guarantee that patients will use them. The process needs to be interactive, allowing patients to upload information (eg from diet and fitness apps), as well as receive it. Some patients are already using apps to count the number of steps they take each day or the number of calories they consume. With the growth of genomic analysis and precision medicine, targeted health interventions and lifestyle advice based on personal data will become increasingly important.

There is professional scepticism, too. Research for the Sowerby e-Health forum, a group of experts investigating uses of medical data at the Institute of Global Health Innovation, at Imperial College London, established to improve global healthcare through evidence based innovation, shows almost two thirds (62%) of 152 GPs and more than a quarter of 350 hospital doctors (29%) fear that giving patients access to their records will increase their workload.

The research, due to be presented at a conference on data sharing taking place in London next month, found almost one in ten GPs (9%) said it would make patients’ health worse.

Less than one in five (19%) believed it would improve their health. Hospital doctors were only slightly more positive with just over one in four (29%) saying access would make patients’ health better.

A key NHS target is to improve self care by people with chronic conditions. But the survey suggests GPs are pessimistic, with fewer than one in five saying access to records will improve these patients’ understanding. Hospital doctors are more optimistic with more than half (58%) saying it will boost understanding.

Doctors have an understandable fear that the more patients trawl through their records, search the internet, and consult “Dr Google,” the more problems they may bring to the surgery.

An earlier study of patients in Norway who were given the ability to communicate with their doctors electronically found they raised more health concerns than in a face to face consultation in the surgery That improved satisfaction for the patients but appears to have left the doctors feeling overburdened and unable to decide where to focus their attention, with a potentially worse outcome.

The Care Information Exchange project is designed to provide patients with the ability to view, add to, and share information about their care, and communicate online with health and social care professionals in their network.

The development of the digital NHS will help put patients at the centre of care, making them more self-reliant and better able to manage their conditions, thereby reducing the burden on doctors. That is the goal.  But doctors will need to be reassured that it will make their task easier, not more complex.


Lord Darzi is a surgeon and director of The Institute of Global Health Innovation, established to improve global healthcare through evidence based innovation He was a Labour health minister from 2007-9.

The Sowerby Symposium takes place on 14 September 2016 at The Royal College of Physicians, London. More details can be found at this link

Competing interests: For a full list of registered interests, see the parliamentary register.  The research referenced in the post has been funded by the Peter Sowerby Foundation through academic grant funding for the Institute of Global Health Innovation’s E-Health ForumGoogle is referenced in the article. The author has received stock payments from Google DeepMind for its acquisition of an Imperial College start-up company.