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Watching the UK Careen Toward National Online Medical Records


The National Health Service in the UK has rolled out its campaign to inform the public that an individual's online summary care record will soon be readily available to any health care worker. At that point, people will be able to view their summary, schedule hospital appointments and make use of health information and links to help them 'manage their health and lifestyle by keeping track of information like your weight, blood pressure, cholesterol levels and medications.

Millions of people received a letter informing them of this change. The letter gave them the chance to opt out of the online-only program by going to a Web site, downloading a form, filling it out and sending it by snail-mail to their physician.  If you don't send this letter, your consent is presumed. And if you don't have access to a computer, it is your business to find someone who does who can help you out.

If you are in the one quarter of UK adults too poor, too old, too ill or too obstinate to conduct your life online, this new policy will motivate you to get with the program.

This nudge toward the use of electronic health records is part of a larger plan of choice architecture written about by Richard Thaler and Cass Sunstein, and in the UK it is only one of many nudges intended to move the interactions between the people and institutions online. Employers insist on online applications; banks, travel services, insurance and utilities provide incentives to abandon the paper-in-the-mail approach. The government in the UK, in particular, is making a concerted effort to move all interactions with the public online, from lodging complaints to applying for subsidized housing.

The picture of electronic health records is different for us in the U.S., if for no other reason than that the effort to adopt them is a long way from implementation for most physicians. Access to a secure, portable record of our medical information to which we have full access is even more distant.

The messy way we either reach consensus in the U.S., or at least choose from a multitude of options will give us time to work some of these issues out while observing the UK process unfold.

We should be able to learn a lot about how individuals actually use their health records and the ancillary services the patient portal offers. After all, what people want and what works best for a "system" may not always be the same thing. And the UK experience may help us to estimate the size and shape of the help needed for those who haven't made the transition to life online.

More Blog Posts by Jessie Gruman

author bio

Jessie C. Gruman, PhD, was founder and president of the Center for Advancing Health from 1992 until her death in July 2014. Her experiences as a patient — having been diagnosed with five life-threatening illnesses — informed her perspective as an author, advocate and lead contributor to the Prepared Patient Blog. Her book, AfterShock, helps patients and caregivers navigate their way through the health care system following a serious or life-threatening diagnosis. The free app, AfterShock: Facing a Serious Diagnosis, offers a pocket guide based on the book. | More about Jessie Gruman

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Comments on this post
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Leanne says
April 5, 2013 at 8:02 PM

I'm so confused as to whether or not this is the right move. While I understand that electronic health records online is a thing of the future and it's easier and more precise I just cant imagine if it were to get hacked. In the US many clinicians have also made the move. Interesting that it's national in the UK.