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One of the most transformative changes to the US health care system in the last few decades has been the widespread adoption of electronic health record (EHR) systems and online patient portals. The patient portal has improved patient access to medical records and facilitated direct communication between patients and their health care teams, improving patient satisfaction, enhancing health care use and increasing treatment adherence. The implementation of online patient portals has altered clinical practice workflows considerably, allowing the streamlining of interappointment communication. However, direct messaging between patients and their health care team is also having a negative impact on healthcare professionals. Increasing reliance on portal messaging as a primary form of communication and more patients using portals increased the volume of messages being sent. Work associated with portal messaging has fallen primarily on doctors, and many of them end up using time outside of clinical work hours to respond. Limited access to appointments has led to more complex and time-consuming messages. This trend is causing higher levels of staff burnout and female doctors are disproportionately affected. This article looks at the issues and potential solutions.

The use of digital health portals, including websites, apps and online consultations, has expanded. The pandemic and increasing public acceptance of digital tools has driven this change. However, this has also led to inconsistency in definitions, language and terminologies used within them, and there is also a significant variation in their functionality. This research by the Professional Record Standards Body (PSRB) and the Patient Information Forum (PIF) aimed to understand the current use of portals and the barriers to increasing engagement for people with long-term conditions to manage their own care better using existing tools and new innovations in the future. Key findings and recommendations User feedback is generally positive about digital health portals. However, there are some barriers to access and use of such portals, including lack of public awareness, lack of proper integration in care pathways, and digital inclusion. Evidence showing the effectiveness of portals in the UK is lacking. However, UK commissioners and suppliers are beginning to see efficiency benefits from appointment portals. These include reducing missed appointments and the cost of printing and postage. Clinicians do not see the benefits of portals. Work plans are not adjusted to accommodate the split of face-to-face and digital work. Digital work is perceived as extra workload rather than a change in model.

Patients, particularly those with long term conditions, have a pivotal role in managing their own health, but too often they are left to struggle without the tools to do the job, the most basic of which is being able to view their medical record. In this article, members of the BMJ's patient advisory panel look at variations in patient access to health records, and the nature and number of portals that patients have to use to access this information. They examine the benefits of giving patients access to their health information and argue that providing easy to use portals will allow patients to effectively manage their conditions and advocate for their own health.

This article highlights three questions tabled in the House of Commons relating to the Yellow Card Scheme, the system for recording adverse incidents with medicines and medical devices in the UK. Yellow Card Scheme The Yellow Card Scheme is intended to support the Medicines and Healthcare products Regulatory Agency (MHRA) monitor the safety of all healthcare products in the UK to ensure they are acceptably safe for patients and those who use them.[1] Reports can be made for all medicines, including: side effects (also known as adverse drug reactions or ADRs) medical device adverse incidents defective medicines (those that are not of an acceptable quality) counterfeit or fake medicines or medical devices safety concerns for e-cigarettes or their refill containers (e-liquids). IMMDS Review and incident reporting Published on the 8 July 2020, the Independent Medicines and Medical Devices Safety (IMMDS) Review, led by Baroness Julia Cumberlege, highlighted the need to improve incident reporting in healthcare, specifically in regards to medicines and medical devices.[2] The Review examined the response of the healthcare system in England to the harmful side effects of three medical interventions: hormone pregnancy tests, sodium valproate and pelvic mesh implants. These interventions have resulted in a truly shocking degree of avoidable harm to patients over a period of decades. One area of particular concern that the Review raised related to the Yellow Scheme, highlighting the need for reform of this system, stating that: it needs to be more user-friendly and accessible that the system was hampered by a lack of awareness among both the public and healthcare professionals. More broadly, the Review recommended that the MHRA needed to revise its approach in relation to adverse event reporting and do more to ensure that it engages with patients and their outcomes. The Government accepted this recommendation in its response to the Review.[3] Questions in the House of Commons Below are details of three written questions tabled by Emma Hardy MP concerning the Yellow Card Scheme. All three questions were answered by Will Quince MP, Minister of State (Minister for Health and Secondary Care). Awareness Question: To ask the Secretary of State for Health and Social Care, what assessment he has made of the level of awareness of (a) health professionals and (b) the general public of the Adverse Events Yellow Card System; and what steps is he taking to increase awareness of that system among those groups. Answer: The Medicines and Healthcare products Regulatory Agency (MHRA) recognises the importance of both public and healthcare professional understanding of, and access to the MHRA Yellow Card scheme, so that they can promptly report any concerns they have about the safety of healthcare products. The MHRA monitors the number of reports it receives from members of the public and healthcare professionals and strives to keep improving understanding and awareness of the reporting system. The MHRA continually works to encourage reporting of any safety concerns to the Yellow Card scheme and help improve the safe use of medicines and medical devices for everyone. A sharp increase in reporting, mainly from patients, has been seen due to better awareness of the scheme following significant communications activity at the start of the COVID-19 vaccination campaign.[4] Data collection Question: To ask the Secretary of State for Health and Social Care, what assessment he has made of the (a) level and (b) adequacy of data collected by (i) mandatory and (ii) voluntary reporting of adverse clinical events by health professionals before the introduction of the Yellow Card reporting system in England compared to that now collected via the Yellow Card system. Answer: The Medicines and Healthcare products Regulatory Agency (MHRA) has reviewed other international mandatory and non-mandatory reporting systems for healthcare professionals and found limited evidence that making reporting mandatory increases the ability to detect safety signals. Very few international mandatory reporting systems have a better reporting rate or a more successful system for detecting safety signals than the United Kingdom. In both medicines and devices legislation there are requirements for manufacturers to report, but there is no legal obligation for healthcare organisations. However, there are professional body standards and guidelines that make reporting a gold standard for healthcare professionals. The MHRA continues to work with partners across the healthcare system to promote and encourage use of the Yellow Card scheme to help detect safety issues. The MHRA has reviewed global approaches to mandatory reporting in other regulatory systems and continues to consider the approach in the UK as we work to improve reporting capability and functionality through systems.[5] Data analysis Question: To ask the Secretary of State for Health and Social Care, which body has responsibility for analysing data collected by the Adverse Events Yellow Card system; and what assessment has he made of the potential merits of collating this data on a publicly accessible database. Answer: The Medicines and Healthcare products Regulatory Agency (MHRA) collects and analyses the data received through the Yellow Card Scheme, and publishes data on medicines and COVID-19 vaccines in a searchable database on the Yellow Card website for transparency purposes. As outlined in the Yellow Card Privacy Policy, the MHRA has responsibilities under both the UK General Data Protection Regulation and the Data Protection Act 2018 to protect confidential data and personal data pertaining to individuals. The content and format of the data is currently being enhanced in line with patient and healthcare professional feedback and will be expanded to include medical devices in due course. The data provided will continue to be aligned to the MHRA’s legal responsibilities to data subjects.[6] References MHRA, Welcome to the Yellow Card reporting site, Last Accessed 6 June 2023. The IMMDS Review, First Do No Harm: The report of the Independent Medicines and Medical Devices Safety Review, 8 July 2020. Department of Health and Social Care (DHSC), Government response to the report of the Independent Medicines and Medical Devices Safety Review, 21 July 2021. House of Commons, Yellow Card Scheme, UIN 186945, tabled on 25 May 2023. House of Commons, Yellow Card Scheme, UIN 186944, tabled on 25 May 2023. House of Commons, Yellow Card Scheme, UIN 186946, tabled on 25 May 2023. Related reading A year on from the Cumberlege Review: Initial reflections on the Government’s response (Patient Safety Learning, 23 July 2021) Response to the Select Committee report on the Independent Medicines and Medical Devices Safety Review (Patient Safety Learning, 20 January 2023) Regulatory flaws: Women were catastrophically failed in the mesh, Primodos and Sodium Valproate tragedies (Kath Sansom, 15 April 2021)

The Yellow Card Scheme helps the Medicines and Healthcare products Regulatory Agency (MHRA) monitor the safety of all healthcare products in the UK to ensure they are acceptably safe for patients and those who use them. On the Yellow Card Scheme website you can report a suspected incident or problem.  Reports can be made for all medicines including: side effects (also known as adverse drug reactions or ADRs) medical device adverse incidents defective medicines (those that are not of an acceptable quality) counterfeit or fake medicines or medical devices safety concerns for e-cigarettes or their refill containers (e-liquids).

A short video to show you how to have a video consultation with your GP surgery after receiving an invitation via text message.  Increased use of telephone and video consultations is expected during the current COVID-19 situation. In this video, the AccuRX (https://www.accurx.com/) system is being used. The system and process used by other practices may vary. A link to this video can be sent to a patient's phone by the surgery when a video appointment is booked so that they can prepare themselves for their video consultation.

The use of patient portals to send messages to healthcare teams is increasing. This JAMA Network Open cross-sectional study of nearly 40,000 US patients aimed to find out whether there are differences in how care teams respond to messages from Asian, Black and Hispanic patients compared with similar White patients. The authors found that messages asking for medical advice sent by patients who belong to minoritised racial and ethnic groups were less likely to receive a response from doctors and more likely to receive a response from registered nurses. This suggests these patients receive lower prioritisation during triaging. The differences observed were similar among Asian, Black and Hispanic patients.

This study in BMJ Open aimed to describe the experiences and opinions of GPs in England about patients having access to their full online GP health records. 400 registered GPs in England completed an online survey. The results revealed some key findings: 91% GPs believed a majority of patients would worry more. 85% said they though patients would find their GP records more confusing than helpful. 60% believed a majority of patients would find significant errors in their records. 70% believed patients would better remember their care plan. 60% said patients would feel more in control of their care. 89% believed they will/already spend more time addressing patients’ questions outside of consultations. 81% said that consultations will/already take significantly longer. 72% said they will be/already are less candid in their documentation after online records access. 62% believed patients having access to their records would increase their litigation.

This cohort study examined whether sociodemographic characteristics affected patient access to and use of patient health care portals during the Covid-19 pandemic. The authors found significant disparities in portal use by sex, age, multimorbidity and health literacy were found. While disparities by sex and age decreased and were no longer statistically significant by 2021, disparities by multimorbidity remained consistent throughout the pandemic and disparities by health literacy were exacerbated.

TCC-CASEMIX has created a unique infrastructure to provide total traceability of medical device performance. This infrastructure is supported by The Association of British HealthTech Industries [ABHI]. We refer to it as an 'Open Registry Infrastructure' for medical devices. It is 'open', because unlike existing clinically focused registries, which are 'closed', we enable wide searches across the registries connected into it. It is 'open' because registries will 'declare the content' (I don't know what I don't know, so how can I search for what I don't know?) Access to this infrastructure is through a Data Access Portal which is being configured for the specific needs of each stakeholder group. We are seeking interest from patient groups who would like to join an Advisory Board to help specify how data should be presented to patients in a way that is relevant and meaningful. Our vision is to link this portal into an enhanced pre-operative assessment process, and to transform patient informed consent.  We are currently developing the Open Registry infrastructure in South West England, and are bringing together medical device manufacturers (from the world's largest to the smallest) and NHS trusts, with their surgeons that already have relationships with specific manufacturers. Using the system: a patient example Imagine that you are in a consultation with your surgeon, who advises that the mitral valve in your heart needs to be repaired. Your surgeon advises that this procedure can be done with minimally invasive surgery. They recommend using Device-X and you ask, "Why, what evidence do you have that this will work best for me?" Your surgeon replies, "This is the best knowledge that we have." You and your surgeon would then access the Portal. You would search for Device-X, maybe with a specific Unique Device Identification number (UDI) and/or a GMDN code (all of this is presented in a browser to help you search for the correct device). You find from this search that Device-X has been used in patients in three different European countries. You also find that the latest evidence is that it is best suited for patients with large frames, indicating that you may well be better suited to Device-Y. In searching for Device-Y, you also search for the generic description of this device, and find that manufacturers A, D, J and P, all make similar devices of this size, suitable for your needs. Now you search for Adverse Incidents corresponding to Device-Y across all of these manufacturers, and find that there are incidents associated with manufacturers D and P. This enables you and your surgeon to make a better-informed choice about the device that is right for you. How do we acquire medical device data? We have developed a unique capability to acquire data in real-time during surgery, and in association with device manufacturers. Our tech pushes appropriate data into a local registry and this becomes the foundation of data acquisition across Europe. We are already working in Central and Eastern Europe, and are planning a major initiative in Ireland. The Advisory Board comprises: Medical device safety experts Regulatory and Compliance experts Cyber security and data protection experts Patient advocacy experts (unfilled) Notified Bodies (unfilled) The board is chaired by an expert who has been chief executive of two NHS Trusts and worked for NHS England. It is coordinated by a trained anaesthetist and clinical safety expert. The board is also supported by a roundtable of medical device manufacturers, who are committed to making this work happen. They are also committed to total transparency of data. They are funding this work. The support we have been receiving from medical device manufacturers has been astonishing. This is a major opportunity to contribute to patient safety and help transform the patient consent process. If you are interested in finding out more, please contact [email protected]

My Planned Care gives you advice and support while you wait and helps you to prepare for your hospital consultation, treatment, or surgery. This includes giving you information about waiting times at your hospital and other supporting and local services while you wait. This site is updated weekly and can be viewed by anyone, which means you, your family or carer as well as your NHS team can all see the latest information. Your hospital team will be in touch with you as soon as they can. If you are looking for an update, please check this website before contacting your hospital or GP.