Could YOU become part of the 4th Emergency Service ?

Yesterday, the unthinkable happened. The surgery’s main server was off, the VOIP telephone system was down at the branch and we could not access the internet or our clinical system. That has never happened before. An underground cable close to our medical centre was accidentally cut leaving a whole area of Haughton Green without power. We were informed that power may not be restored until 4:30pm.

Unthinkable? Yes. Unimaginable? No.

We at Haughton Thornley Medical Centres are very fortunate. For over 13 years, we have been preparing for just this very eventuality and to activate the 4th Emergency Service – you! Whilst the power was down in the surgery, patients like you could still access your own electronic health record via your smartphone / tablet using a 3G / 4G connection. That connects your device to the cloud independent of any local power problems. It literally bypasses any local issues and becomes a lifeline when the need arises. We have been asking patients of ours just like you to sign up for our online service using an explicit consent process so that you can safely view your electronic health record, gain a better understanding of your healthcare needs and choose to share your information with whom you like at the point of care. You can then view and share your problems list, medications, allergies, test results, letters, scan results and even the details of consultations you have had including the free text. Click here to try out the test patient. You become part of the 4th Emergency Service alongside the police, ambulance and the fire brigade! We now have 7091 patients (58% of our total patient population) with full access to their whole GP electronic health record.

So what happens when a practice like ours suddenly loses power and cannot access electronic health records?

• All staff are informed that patients can still view their electronic health records still and to use this access to view them with using either the patient’s own device or their own if they have a device and can do so.
• Staff are immediately informed to ask patients who are contacting the surgery to bring their pin numbers and smartphone / tablet in so that they can log into their record and share this with the clinician
• A message is posted on the home page of the practice-based web portal www.htmc.co.uk, facebook and twitter to inform patients there has been a powercut, to expect some delays, to postpone any visits to the surgery unless absolutely necessary and to bring their passwords with them to share with the clinician

• Patients coming to the surgery who have not yet signed up for full access to the GP electronic health records are asked to complete the paper-based or online questionnaire so that they may be better prepared for next time and also to start using online services too.
• Our local Clinical Commissioning Group sends out a message to all the local practices to inform them about a problem at our surgery and informing them about the benefits of patients accessing their electronic health records after Wendy Povey our practice manager explains the benefits

• Ingrid Brindle, the Chair of our award winning Patient Participation Group posts on twitter a reply to thank the practice and also recognise the Paradigm Shift where doctors are asking patients for their information for a change

What sorts of patients did I see who had access to their full GP electronic health records?

• A young mother with chronic low back pain
• A baby girl with constipation
• A young lady with Achilles tendonitis and who also wanted a discussion about contraception
• An elderly lady who suffers with sleep apnoea syndrome and had been very breathless but was better now and needed reassurance
• A Bengali child needing advice and guidance. Dad had all the passwords for his family stored safely on his smartphone and so could easily log in.
• I did a visit where the husband had access to his wife’s electronic health records and could share details with me. The 4th Emergency Service in the home where care is delivered.

Being able to see the whole GP electronic health record makes it easier to check details and also provide continuity of care with the patient pointing out salient points rather than me trying to do it all on my own. We do this together. Patients either logged in using their smartphone or I have a tablet with a 4G connection and so could use this to view the records with.

Of course it was not all plain sailing and not everybody is yet fully on board

• A pregnant lady rang to see if we had received a letter yet from the gynaecologists about changes needed for her medication. She had not signed up for access to her records and so all we could do was ask her to call back later. The clinical advice had to be delayed.
• The family of a young Bengali child with a blocked nose for a long time had access to his records but they had forgotten his passwords and so could not view the record
• An Asian man had developed an allergic rash to the pain patch he was applying. He had not slept for 3 days and we could not check what other medication he had tried.
• A young English person who had a long history of diarrhoea and loose motions had been investigated in the past and then discharged. Her symptoms had returned and Mum wanted to know what to do next. Without access to the records, it is more difficult to know what to do next. She had signed up for access to her records but had never used it.
• One very elderly lady had given her passwords to her daughter and asked if I could call her. When I rang her daughter, she did not have her passwords with her and so was unable to help.
• Patients came to the surgery but did not have their passwords and so were unable to sign in.

This is just a selection of the patients I dealt with yesterday – some on the phone and some face to face. The power eventually came on at around 12:30pm and we were able to restore services back to normal. Fortunately no patients came to harm and we were able to catch up before the end of the day. We updated the message on the practice website as well as on twitter and facebook.

What lessons can we learn?

• Patients like you can become part of the 4th Emergency service if you are invited to have full access to your records and are actively encouraged and invited to sign up
• Keep your passwords in a safe place with you at all times so that you can use it whenever you want. This is just as important for carers (or other family members who are doing it on your behalf).
• There are secure ways of storing passwords on apps on your smartphone or tablet which you can then easily access when need be. Other solutions may include using finger-print technology to enhance the security further. Security is important and so is the ability to access vital information when it is needed most.
• Use every opportunity to inform others like you, engage you and actively encourage you to sign up for online services including full access to the electronic health record and gain an understanding too. #RecordsAccessAndUnderstanding
• The practice-based web portal www.htmc.co.uk and the main website is a treasure trove of trusted information to support patients and their carers manage their healthcare needs
• Inform patients who have not yet signed up why it is important for them to do so and to congratulate those that have because they (just like you one day) are the 4th Emergency Service!
• Our management team led by Wendy Povey and our staff and Patient Participation Group led by Ingrid Brindle are a critical part of delivering care 
• All people interested in delivering safe quality services should now think about the 4th Emergency Service and what we are doing to set this up. This requires investment, education, training and a culture of continuous improvement which involves everybody – patients, carers, frontline staff, back office staff, management teams, clinicians and of course those who commission and provide healthcare service. We are all in it together and that is how we keep the system safe for all.

This is all part of the Partnership of Trust. None of us think we need this until the unimaginable happens and we need to access healthcare. Be a part of the Emergency Service. Be a part of the Team. We need to responsibly share the electronic health record with our patients just like you as well as allowing you to then share this with others when asked to do so. Yesterday we asked patients to share their electronic health records with us. One day, we will all thank you for helping us to deliver safe, quality care together!

The 4th Emergency Service. You!