The impact of electronic personal health records on the healthcare of patients living with coercive control and abuse

The aim of this proposed research is to establish the impact Electronic Personal Health Records (EPHRs) in general practice will have on patients, practitioners and other agencies when patients are in coercive or abusive relationships. In achieving this aim I intend to work closely with the people who have experienced coercive relationships to ensure that my work addresses their concerns.

By 2020 the Government intends that electronic personal health records (EPHR) are accessible to every adult in the UK via the internet. This means that patient investigation results, prescriptions, diagnostic codes and eventually the full record, will be available for the general population to access from their personal computers and smartphones. There is also a shift to incorporate shared information and records into tools such as the 'diabetes digital coach' to help patients manage their health conditions. It is argued that many people will benefit from these changes. Practices have already started to use a basic or full version of the on-line access system and believe that it has brought improvements to the care of their patients. A utilitarian and deontological basis for their arguments is evident. They believe that on-line records are liberating for doctors and patients and increases patient understanding and involvement in their health care. In essence 'no decision about me without me.'

However, some patients are in a vulnerable situation and are living in an environment of manipulation and coercion from the people who may be closest to them, but do not genuinely have their best interest at heart and are exploiting the individual for their own gain. It has been suggested that under these circumstances having EPHRs available at home could increase risk of abuse and compromise the healthcare of a certain group of patients. Supporters of EPHRs believe that risks to patients in abusive relationships can be managed by the practice, (Hannan, 2011) however to date there is a lack of evidence on how to do this. Existing studies indicate that there are improved levels of patient self-management, knowledge, communication, satisfaction and trust when using EPHRs although this is inconclusive (Cruickshank et al, 2012) To date no research has been published looking at how this will affect certain groups of the population such as those in controlling or abusive relationships.