'Getting it write' in an era of online electronic health records access in primary care: A qualitative study exploring the needs and requirements of underserved patients and carers.

Abstract

Most adult patients in England now have access to their primary care electronic health record (EHR), including free-text consultation notes, via the NHS App or other online services. As EHRs were not designed for patient audiences, this study aimed to explore patients' and carers' perspectives and understanding of simulated consultation notes. One interview and five focus groups were conducted with 26 patients and carers from a purposive sample of underserved communities in England between April and May 2023. Participants' understanding and views were elicited regarding five vignettes about patient consultation scenarios and corresponding simulated primary care EHR entries. Verbatim transcripts were analysed inductively using thematic analysis. Most participants struggled to fully understand the simulated consultation notes, particularly medical acronyms, clinician shorthand and non-clinical abbreviations. Participants also identified issues which may cause unintended offence or anxiety, and made suggestions about how EHRs may be improved to meet the needs of patient audiences and maintain positive patient-clinician relationships. Opening up online record access to include patient audiences necessitates a significant cultural shift in the way that consultation notes are written and used. Participants proposed technological and documentation adaptations to enhance understanding, support diverse patient needs and maintain positive patient-clinician relationships. To fully realise the benefits of patient online records access, it is important for consultation notes to be written in a way that patients find meaningful, while maintaining their clinical integrity. To optimise NHS England's investment in this policy and avoid exacerbating health inequalities, it is essential to ensure all patients can access the benefits of online access to their EHR. Healthcare professionals need to be supported to manage the challenges of writing consultation notes for patient audiences, while continuing to maintain effective clinical care.