As part of disable sharing functionality, we have been reviewing what this means for features in the system which intrinsically support collaboration and sharing, namely shared care plans and patient-professional messages. This post clarifies the behaviour of these features.
Care plans
All professionals contributing to a care plan will have permanent access to that plan. A team can initially contribute to a plan if their privacy access allows (i.e. the plan has a privacy label which the team has access to). Once they have contributed to the shared plan they will continue to have access, even if the privacy label of the plan changes.
If the patient disables sharing of their record:
- Teams can continue to see the plans they contributed to. This is consistent with other data points – teams can always see data they added. In this case contribution to a shared plan grants entitlement to maintain a view.
- New care plans cannot be created and edits cannot be made to existing care plans, i.e. the shared care planning feature is not available with sharing disabled.
- This should be communicated to patients by the Privacy Officer when discussing disabling sharing.
Future enhancement: PKB will be enhancing its care planning functionality in light of PRSB guidance. These care plans will contain structured data and will therefore, unlike the above, support more granular access rules for sub-components. More details will follow.
Messages (including consultations)
Message chains can contain replies from different teams involved in the patient’s care and therefore intrinsically support sharing of information between teams.
Professionals are always able to see messages addressed to them regardless of privacy settings. Professionals added to a chain mid-way are able to see all messages from the start of the chain. Professionals removed from a chain are able to see all messages to the point they were removed.
Currently privacy labels are applied per message within a chain. We will be making a change to apply one privacy label for the entire thread, i.e. changing the privacy label will change it for the entire chain, not just that message. This will mean that it is not possible to be missing messages within a chain – either all messages are visible or none (if no privacy access or not a recipient).
If the patient disables sharing of their record:
- A professional can continue to see the message chains they are a recipient in.
- We will disable the ability for any further messages, including consultations and replies to be sent. This is to prevent the sharing of information that could be added to a chain after the patient has requested sharing to be disabled.
- This should be communicated to patients by the Privacy Officer when discussing disabling sharing.
You need to stop being paternalistic. Surely lack of capacity should be proved by a ‘professional’ to stop a patient disabling sharing, rather than a patient proving they have capacity by providing informed consent? Capacity should always be presumed, unless there is evidence to the contrary