Dr Amir Hannan is no ordinary GP. Depending on your point of view, he is an
internet pioneer, the future of British medicine or a worrying maverick.
But then Dr Hannan's practice, Horton Thornley Medical Centres in Hyde,
Greater Manchester, is no ordinary GPs' practice.
The people he looks after were once treated by Harold Shipman. The GP and
convicted serial killer, who hanged himself in prison in 2004, was blamed by
an official inquiry for 215 murders and 45 other suspicious deaths. The bond
of trust between doctor and patient was shattered in this community - and
medical records were at the heart of the problem.
Shipman abused these secretive files, prescribing drugs in people's names
without their knowledge. To overcome the fear his predecessor created, Dr
Hannan knew that he had to give power back to the people. The internet gave
him the way to do it and the lessons of Hyde could mean that we are all soon
logging on to our medical records.
With the help of a highly secure web portal, Dr Hannan's patients can read
every word of their records by logging on to any computer, anywhere. And
they can read updated files almost as soon as an appointment has ended.
Blood-test results are scanned in, which means that “getting the results is
like online banking” and patients can easily find out about everything from
their travel vaccination record to illnesses they suffered as a child.
Patients can access information anywhere
This transparency has gone a long way to restoring trust, says Dr Hannan. But
for those who read their records, the benefits have been far greater. The
crash course in their medical histories means that they are “in the fast
lane”, he says. “They know their cholesterol levels, their blood pressure,
they are at one with their health. They are more compliant with medication -
taking their tablets - because they understand it.”
Online records can also be accessed any time, any where. Dr Hannan recently
took a phone call from a bemused French casualty doctor who said that one of
the GP's patients had suffered chest pains on holiday and had asked him to
log on to his record. “He said that he didn't believe that you could access
medical records online,” he recalls, delighted to have set the French doctor
right.
Armed with such examples, Dr Hannan has little patience with medics who stress
the risks of opening up the once secret volumes that detail our health.
“Very few people have come to harm because information was shared,” he says.
“In my practice, thousands of people came to harm because it was not.”
Dr Hannan's scheme was born out of unique circumstances and, since its launch
in 2006, has been rolled out to only a handful of other practices. But he is
also working to ensure that patients everywhere are beginning to log on to
the benefits of online medical records through his involvement with the
NHS's online personal health organiser, HealthSpace.
HealthSpace is a web portal that is part of the Government's much-criticised
£12.7billion National Programme for IT (NPfIT). For several years it has
offered a “basic account”, allowing all NHS patients to create a health
diary by inputting information about their height, weight and ailments.
About 500 people a week are signing up for these accounts, but for patients in
pilot areas,including Bolton and Bury, HealthSpace offers an “advanced
account” that is starting to provide access not just to our own data but to
records that medics have been making about us. With the people behind
HealthSpace about to ask the Treasury to fund a huge expansion of the
service, could it soon join Amazon and Facebook on our list of most used
websites?
It is a long way behind Hyde, but Dr Gillian Braunold, the project's clinical
director, has ambitious plans. She hopes that through our HealthSpace
accounts, we soon may be viewing a host of medical records, scan results and
X-rays, as well as performing a range of other health-related tasks online.
By early next year, if all goes to plan, patients in some parts of the country
will receive screening invitations, complete pre-treatment questionnaires
and e-mail clinicians - perhaps attaching a digital photograph of that pesky
ulcer - from wherever they happen to be.
Patients will be able to annotate records
They will be able to offer their thoughts on treatment by annotating, though
not editing, records created by medical staff, and carers will get separate
logins for their relatives' accounts.
Dr Braunold envisages that about 5 to 10 per cent of the population might
register within the next three years, and while she acknow-ledges that it is
not for everyone, she hopes that it will become a “must-have” for those with
long-term conditions. Whether you are a diabetic who wants to keep tabs on
your blood glucose levels, or a terminally ill patient, keen to travel but
wary of being away from your records, HealthSpace may become the ultimate in
portable health histories.
But there is a problem. NPfIT, the largest non-military IT project in history,
remains mired in delays and controversy, from which HealthSpace cannot
remain immune.
One of NPfIT's key targets is to provide medical staff with centralised
electronic information on 50million English patients, but the scheme is
running years overdue, and has so far cost £3.6 billion. The National Audit
Office predicts a completion date of 2014-15, amid concerns about privacy,
wrangles over consent and the “termination” of contracts with suppliers.
Once our records are updated to a central “spine”, many thousands of NHS staff
from London to Newcastle will be able to access each patient's private
medical information, a move that has prompted security fears.
Michael Summers, the vice-chairman of the Patients' Association, says these
concerns are heightened in part by the recent string of data losses by
Whitehall departments. But the losses are also a reason why more people want
to take charge of their own records, online or otherwise: “There are a lot
of people who want to hold their own records. I see no reason why that is
not the future.”
Ever-present spectre of hackers
HealthSpace carries its own security risks, including the ever-present spectre
of hackers.But one advantage of a patient-controlled online system is that
each person is responsible for the security of his or her account.
Perhaps surprisingly, given NPfIT's problems and the NHS's reputation as a
technological dinosaur, HealthSpace is also riding the crest of an
international wave. In the US, Google and Microsoft have recently unveiled
their own services, Google Health and Health Vault, that they hope millions
will use to become masters of their own healthcare.
Patients who use Google Health can download data from home medical devices
like blood pressure testers. Most tellingly for the future, though, is that
patients of a few American partner clinics, including the Cleveland Clinic
in Ohio, can already access their clinical records via Google Health.
Marissa Mayer, the company's vice-president of search products, has said
that she hopes Google Health will eventually include “thousands of partners
and millions of users”.
The NHS may look to Google or Microsoft
Whereas Google and Microsoft have conquered the world through their high-tech
mastery, the NHS is still feeling its troubled way through a computerised
minefield.
Trisha Greenhalgh, Professor of Primary Health Care at University College
London, who evaluated the HealthSpace pilots, described the basic
HealthSpace account as “incredibly clunky, like a pair of NHS glasses with
plastic frames”.
It is not unfeasible, therefore, that developments on both sides of the
Atlantic could one day meet. Linda Davidson, director of eHealth Insider,
the specialist news service, says that the health service may yet look to an
expert like Google or Microsoft to provide the technology to make online
records work: “Just like when the NHS needs scanners or X-ray equipment,
they don't go into a laboratory and create their own. If I was in the
policy-makers' shoes I would be looking hard at whether that is the way to
go.”
Dr Hannan, evangelical about the potential of online records to create
“empowered patients”, agrees that Microsoft and Google might have a role to
play. But above all, he says, he is pleased that the two companies have
moved into online records “if only because it makes people think its going
to happen. The minute you say the NHS is going to do something, an IT
project, people say forget it. But we are ahead of the game.”
If his enthusiasm is anything to go by, we should all be watching this
HealthSpace.
CASE STUDY: 'It has changed my relationship with the doctor'
Yvonne Bennett, a patient of Dr Amir Hannan in Hyde, Greater Manchester, is
one of a select group of UK patients who can view their medical records
online. Hannan adopted the system to increase transparency and trust between
doctor and patient, as many of his patients were once treated by serial
killer Harold Shipman.
For Bennett, logging on to her medical records online has dramatically changed
what it means to be a patient. “I really feel in control of my health,” the
60-year-old says. “It has changed my relationship with the doctor: it has
become a discussion when I see him, rather than him saying Do this, do
that'.”
Mrs Bennett has Ehlers-Danlos syndrome, a connective tissue disorder. From her
home computer, she can examine X-rays, check blood-test results and read
scanned copies of letters from hospitals to her GP. Rather than crossing her
fingers that a new consultant or neurophysiotherapist will know her medical
history, these days she takes a printout of the relevant information.
She says that most doctors are “very grateful” and that it leads to quicker
treatment. It would have been even better, she adds, if online records had
been available while her mother was alive. She suffered strokes towards the
end of her life and Mrs Bennett often ended up with her in A&E. “They
never had her records. I was expected to rhyme off all her medication and
conditions.”
Online access is part of her life now. Her diagnosis? “Really good.”
Online patient records open up the possibility of more and more medical services being available online. If a patient in rural Scotland gives a doctor in London access to their online patient record, it suddenly becomes feasible for more and more specialist services to move online.
ian van every, london,
I too am a patient of Dr Hannan and I am grateful for the supreme efforts undertaken by him and his team to pull the NHS up by its bootstraps and drag it into the 21st century .
The approach to medicine at this practice is refreshing and innovative and promotes fuller understanding of healthcare .
S Matley, Haughton Green , UK
I am patient of Dr. Hannan and since he has taken over the old Shipman practice he has worked tirelessly to overcome the loss of confidence we had. The fact that I can see my records at home means that I have fuller understanding of my illness.
J Shepley, Hyde,
I have had Type 1 Diabetes for 38 years. The greatest risk to my health in an emergency is the lack of an easily accessible personal health record, not the fact I have one. We need some more of Dr Hannan's pragmatism and less paranoia!
Bruce Elliott, Darlington, Co Durham
I am a patient at the Haughton Green practice ( note the spelling of Haughton, editor), Access to my medical records online undoubtedly empowers me. I can look at test results in detail, book appointments etc. Dr. Hannan should be praised for his innovative approach to medicine in the 21st century.
L Hinds, Denton, UK
Local possibly. National NO,NO,NO. Govt. has not a clue and if Microsoft is involved, NO to local as well. Such a combination is the road to certain disaster.
M. Cawdery, craigavon, Co. UK, EU (now)
As a patient of Dr Hannan at the Haughton Green practice I wholeheartedly support his new system. clearly he is a pioneer. I need to see him on a regular basis and am able to discuss hospital results with a much greater understanding and ask informed questions instaed of leaving the Surgery bemused
Brian Wetherell, Denton, UK