[Re: https://www.hifa.org/dgroups-rss/adoption-electronic-health-records-nurs... ]
As electronic health records are adopted in Africa by nurses it might be worth considering patient access to records at the beginning of the implementation of EHRs rather than later. Patient access to records is proving to be an effective adjunct to clinical care and midwives in the UK have been sharing their records with patients for decades.
The future of digital health records in relation to patient access to records was discussed in the December 2025 World Medical Journal WMJ_04_2025.pdf [ https://www.wma.net/wp-content/uploads/2025/12/WMJ_04_2025.pdf ] and I have pasted the questions and answers below:
Question: What are four ethical considerations that continue to challenge physicians with incorporating patient access to their records into digital health to enhance clinical care and shared decision making?
Firstly, clarifying the processes of confidentiality: Personal health data is confidential to the doctor and patient, but confidentiality should not preclude patients from seeing their own data. Patients should be able to view their personal data, albeit with a few exceptions.
Secondly, providing sufficient information to patients to explain their personal health data that physicians share with them: Informed patients are better prepared to give consent to proposed care and health interventions, when they are provided information that is tailored to their level of literacy and linked to their patient accessed records.
Thirdly, deciding whether to allow patients to see their personal health data during or before their medical appointment: Physicians have traditionally shared “bad news” to patients, which requires empathy, and compassion in the delivery. However, one multi-site research study of more than 8,000 surveyed patients in the United States found that most patients preferred receiving their medical results immediately, and before physicians’ formal reviews or consultations [1].
Fourthly, finding a way for physicians to make their findings and notes available to physicians in other hospitals: Physicians treat patients with complex medical histories from other hospitals, specialties or countries with difficulty when they have no access to the previous medical records. Physicians will minimise this difficulty when they allow their patients to share their personal health data wherever, whenever, and with whoever they wish.
Question: How can they work together to address these challenges?
When physicians prepare their clinical notes, they should routinely include a recommendation that allows patient access to their digital records, especially when patients are in long-term health plans. Physicians’ development should cover the etiquette of writing notes that can be shared with patients and how to work with patient data in the digital world.
Question: Can you describe two lessons learned during the COVID-19 pandemic that prompted the need to improve healthcare practice, safety, and patient agency?
Firstly, the National Health Service (NHS) promoted the NHS App widely in response to the COVID-19 crisis. The NHS App was used to communicate with patients who were in quarantine and unable to visit health facilities (https://digital.nhs.uk/ services/nhs-app). Patients learned to use the NHS App to manage medical appointments and vaccinations, order repeat prescriptions, and to present their medical histories to health professionals. They obtained health information, chose how the NHS uses their data, received instant health advice, and requested medical assistance. Notably, over one million individuals had signed up for the NHS App by December 2019, and a total of 33.6 million individuals by November 2023 [4]. continuing professional
Secondly, the NHS learned to engage with the public and patients using these digital channels. Patients learned to read and use their health records for work, travel, and to plan their health. They learned to grant the NHS permission to contact them for vaccinations, and to trust the NHS App with their personal health data for research, planning, and audit purposes. The government issued the Regulation 3(4) of the Health Service (Control of Patient Information) Regulations 2002 during the COVID-19 pandemic in 2020, requiring the sharing of confidential patient information among health organisations (and other appropriate bodies) to protect public health and provide healthcare services BACK TO CONTENTS 45 Interview with the Family Medicine Expert during the outbreak monitoring and response.
Question: How can physicians lead efforts to facilitate patient access to their records to effectively ensure patients’ rights in clinical practice, while striving to safeguard autonomy in decision making processes?
Clinical tutors can provide physicians-in-training with the knowledge, skills, understanding, and attitudes, to share digital health records with patients . Physicians can advise and encourage patients to access their digital health records during consultations, and they can collaborate with information technology suppliers to develop and enhance patient portals.
Question: Can physicians who support patient access effectively ensure patients’ rights in clinical practice while striving to safeguard autonomy in decision making processes?
Data access, physician-patient rapport, autonomy, and shared decision-making align directly with the World Health Organization (WHO) Patient Safety Charter, which describes 10 patient rights. 1) right to timely, effective and appropriate care; 2) right to safe health care processes and practices; 3) right to qualified and competent health workers; 4) right to safe medical products and their safe and rational use; 5) right to safe and secure health care facilities; 6) right to dignity, respect, non-discrimination, privacy and confidentiality; 7) right to information, education and supported decision making; 8) right to access to medical records; 9) right to be heard and fair resolution; and 10) right to patient and family engagement [5].
Patient access to records is a strong supporter of patient respect and dignity, leading to patients who feel more respected and dignified in clinical encounters. Notably, nine rights (all except 5) are linked to patient access to records, and three rights (rights 1, 7, and 8) support autonomy in decision-making processes.
Question: How do you anticipate that the widespread use of health apps and patient access to their records will impact patient data, agency, safety, and privacy?
Over the next decade, patient data will become ubiquitous to patients. Health apps will complement and supplement healthcare structures and processes, and communities and villages with limited access to health professionals will be able to access their digital data and health services through these health apps. The promise of secure national health apps will reduce the risk of data privacy breaches currently observed with less secure apps and websites. Furthermore, patients’ trust in data sharing will improve as they access their records, understand how their data are viewed by health professionals, and inspect their records for errors or omissions.
Question: With technological advancements and globalisation, how do you envision the future of clinical practice, patient agency, patient safety, patient access to their records, and the need to protect data and privacy?
Global digital health languages, such as SNOMED CT (https://www.snomed. org/), will unify global health records. SNOMED CT has standardised the digital elements of traditional medicine and has ongoing work to incorporate the International Classification of Diseases (11th revision) (https:// icd.who.int/en/). Patient access to records will be central to health system development, and a global health data governance framework, such as the UN Global Data Compact, will facilitate cross border care, international data sharing, migration, and domestic and international travel.
Question: What innovative tools help physicians to learn more about patient access to digital records and increased patient agency?
Patients’ personal stories are very effective for teaching physicians and administrators to share records with patients. Stories can highlight a holistic framework of patients’ healthcare experience, demonstrate the benefits of patient access to health records, and outline the cultural changes of patient access to records. Personalised testimonies offer additional insight on how to adapt medical education and training programs – including the “humanistic touch” – to improve patients’ expectations, and autonomy, in care and decision-making, as well as strengthening global healthcare service delivery.
HIFA profile: Richard Fitton is a retired family doctor - GP. Professional interests: Health literacy, patient partnership of trust and implementation of healthcare with professionals, family and public involvement in the prevention of modern lifestyle diseases, patients using access to professional records to overcome confidentiality barriers to care, patients as part of the policing of the use of their patient data Email address: richardpeterfitton7 AT gmail.com