Within the UK there are a number of organisations and individuals working towards record access in different ways, at different speeds and to different degrees. A number of different systems are available, doing different aspects of the task.

HealthSpace (www.healthspace.nhs.uk)

The current plan is that people will be able, starting from 2008, to begin to see a summary version of their health records,on a home computer using a protected web service called HealthSpace. At first, they will be able to access medications and allergies, and later other summary information about care and treatment... They will also be able to add information such as access needs, treatment preferences, and eventually self-monitoring information. People must choose to access their records using HealthSpace, and register. The registration process is currently being devised.

GraphNet (www.graphnethealth.com)

This company allows integration and collation of confidential clinical data between different IT health systems. It also offers the potential for sharing between health and other systems, such as Social; Care and Health and Education. It has enabled Hants and Isle of Wight share records for 1.5 million patients between GP practices and hospitals.

GPmail (www.gepmail.co.uk)

Dr Paul Cundy, a GP who is also a member of the BMA GP IT committee has developed a process which enables patients to enter into their own GP electronic health record specific data such as blood pressure and peak flow. This is available to a number of practices, with many thousands of entries having been made.

Foldercare (www.foldercare.co.uk)

Designed by GP Dr Richard Fitton and his patients, the system organises medical data concepts in ways that make it easy for lay people to understand medical terms and ideas. Foldercare also develops new ideas and thinking in the field.

Renalpatientview (www.renalpatientview.org)

Young people with renal problems in Wales and Edinburgh are allowed to see their renal records. A lot of data centres on the investigation results and what they mean. This has been enthusiastically taken up by the patients and their families and appears to have reduced demands on the hospital team.

PAERS/EMIS/InPractice Systems (www.paers.net)

This system is designed by doctors in collaboration with EMIS, and now includes InPractice systems. The system enables patients to see their full electronic GP records, on a kiosk in the waiting room, via a touch screen, patients being authenticated with their fingerprint. The screen contains the same data as held by the GP but reformatted so that it is easier to read and navigate around. The data is linked to health information for the patient. The Health Information Portal (HIP) is available to practices now. In addition, net-based access is currently being piloted. It may be possible to enable 60% of practices across the country to offer net-based access by the end of 2008.

Health eCard (http://www.healthecard.co.uk)

Health eCard offers a simple object like a credit card with a USB attached. This can be fitted into a box in the GP surgery and the full record downloaded. The patient then has their record in their pocket. It can be updated when you go back to the GP. It costs money for both the patient and the practice.

ELECTRONIC RECORD SYSTEMS OUTSIDE THE UK

Record access (RA) is currently available in a variety of formats across the world and includes paper-based access, sophisticated electronic access systems and systems that enable patients to access their records via the Internet (Cimio et al 2002; 2004, PAERS 2004).

Many systems with similar applications to PAERS have been created mainly in the US and Canada. These include: patCIS: web based patient Clinical Information System (Cimino et al., 2000), Winona Health Online, a web based service that gives people access to health information, allows them to create their own medical record and communicate with local healthcare providers (Whitfield 2003), CliniViewer, a tool that organizes and presents the clinical information in multiple records, (Liu and Friedman 2004) and PAMFOnline, integrated EMR system with eHealth application (Tang et al.2003).

Another example is iHealthRecord (http://www.ihealthrecord.org), by Medem Incorporated. Patients retain control and responsibility for their own iHealthRecord, which will eventually include interfaces to EMRs and health plans. It offers secure email consultation with physicians; automatic email medication recall warnings, automatic education programs tailored to individuals, online reminders; and improved access to records.

The Personal Internet worked Notary and Guardian (PING) (http://ping.chip.org) at Boston's Children's Hospital is a Web-based and patient-controlled personal medical records system. It integrates data from multiple care centers and networks, providing patients and families with a confidential and collaborative means of managing their clinical documentation. Its founders contend that the keys to a successful Personal Health Record include patient control over permissions, safeguards to protect patients, and interoperability (data can be included from multiple sources) facilitated by data exchange using public/open standards.

Another example — My CARE Source — soon to be expanded to include patient access to online lab results and electronic health records, offers an enhanced "portal" to personalized disease management support for cancer patients at Grand River Hospital in Kitchener, Ontario, Canada. Patients can monitor symptoms and/or side effects of treatment by accessing care plans. Validated health information and tracking tools promote informed choices and instil a sense of autonomy and control.

The Department of Orthopaedics and Sports Medicine, Seattle has developed the Patient Health Information Management System. PHIMS permits patient consultations. Not only can patients manage their general information and record details of medical problems over time, but consulting physicians are able to review information and clarify details with a patient prior to a scheduled appointment.

Additional examples can be seen at http://www.informatics-review.com/records.html