Recording medical consultations using QRec
It is said that patients recall, on average, around 10% of what is said during their medical consultation. For this reason patients often bring a partner, family or friend into their consultation to assist recall, and the NHS initiative to copy discharge summaries and clinic letters to patients was well received1. With widespread availability of smartphones capable of making recordings, many doctors have been wary about patients making surreptitious recordings, however both the BMA2 and some of the Medical defense organisations3 recently pointed out its advantages and as long ago as 2011 the General Medical Council issued guidance on the matter4 . It was therefore only a matter of time before new technologies, combined with the old adage "If you can't beat them, join them" led SCVC, a leading voice in digital transformative technology, to undergo clinical trials of recording patient consultations.
In 2017, SCVC's Cardiologist and managing partner Dr Edward Leatham conducted a pilot project to assess the feasibility and popularity of recording consultations. Because it requires transfer and storage of a large digital file shared with the patient using a secure cloud record system (QRx operated by Medical Network Services), he called the ground breaking new system 'QRec', reflecting the 'QR' Code displayed on each participating patient's ID Card supplied by partner IT organisation Medical Network Services (MNS).
Preliminary results were encouraging- since the exacting process used by senior PA Paula Bartlett to transfer and store this sensitive material for sharing with the correct patient became fairly routine, and the vast majority of feedback was very positive.
In initial field tests Dr Leatham used a 5th generation Ipod connected to a simple £25 microphone via a meter long cable to the patient's side of the consulting room desk. A dictation app familiar to many doctors (Dictate+ Connect) was installed on the Ipod. This can be set up to upload recordings via wifi to a specific folder (Box.net). Patients were kept informed of the project through a notice within the appointment letter which mentioned the possibility of digital records being made, along with large signs on the reception desk at SCVC. All patients were asked or informed of the recording at beginning of the consultation. For security and in-house identification Dr Leatham started each recording by stating the patient's name and also typed an ID into each unique 'dictation' most conveniently and speedy was to use the patients initials and year of birth - which are unique identifiers in SCVC database, but not outside.
Each recording could be paused and restarted at the doctors discretion, or on patient's request, for example during sensitive parts of some consultations, or if a patient felt uncomfortable being 'on record' during any discussion that was perhaps critical of a professional colleague or family member.
Following each consultation the recording was immediately uploaded to SCVCs secure cloud account - a process that is automatically involves encryption required by both current and new Data privacy laws5. It was then checked by the PA before transfer to a unique cloud record operated by SCVC (its Data Controller) but shared with the patient (a Data subject who has given explicit consent), and as a final privacy check, its first few seconds re-played by the PA responsible for dispatch, to make 100% sure it concerned the correct person before the patient was notified of its existence.
"The system is a little clunky and probably not ready for all my colleagues to use just yet" said Dr Leatham after the pilot project.
Flushed with the success of the project he is now working with the engineering team at startup www.veloscient.com to build recordings of the consultation into a 'patient journey' module running on Veloscient's Notes for mobiles App using an Ipad that each patient will be handed to carry thoughout their visit to SCVC's Guildford One-stop-Heart-shop, located a stones throw from the Royal Surrey County Hospital.
Dr Leatham aims to test whether Veloscients' pioneering new App, running on a patient-held device can be used to collect not only the patient registration, exlicit consents required for datasharing under new 2018 GPDR regulations6, and patient health questionnaire but also be used to for audio recording of the consultation as well as nurse training sessions.
"If we can routinely collect and share these data with the patient it would be a wonderful digital record of what happened during the patient's attendance which is so often poorly memorised, yet may literally may be one of the most important days in the patient's life."
Will this be offered to all patients by all our Consultants? Perhaps one day in the none too distant future, but for now it will probably be only the most enthusiastic that will embrace it.
QRec is supplied and operated by EDPP Services Ltd
- BMJ copy them in 2008
- BMA Blog 2014
- Medical Protection Society Practice Matters Issue 7 2015
- GMC Making and using visual and audio recordings of patients 2011
- Demystifying the EU General Data Protection Regulation – Let’s BUST the Myths 2017
- ICO Guide to the General Data Protection Regulation (GDPR)