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Health feature: Do new electronic health records go far enough?
THE latest NHS initiative in Bucks will help give doctors ‘critical’ information about their patients - but does it go far enough?
The roll-out of Summary Care Records - a computerised database of patient records - will give A&E staff quicker access to information about allergies, medicines you are taking, or any previous bad reactions to medication.
The scheme, set to be introduced at Wycombe and Stoke Mandeville hospitals, could mean the difference between life and death in some cases.
Under the current set-up, clinicians rely on patients to tell them about their allergies and medication, but Dr Geoff Payne, medical director for the NHS Buckinghamshire & Oxfordshire Cluster, says things are not always so straightforward.
He told the Bucks Free Press: "It’s that sort of situation where you have a patient in an A&E unit who’s unconscious and you wish to administer treatment".
"You don’t know what treatment they’re on or whether they would tolerate the treatment you wish to use.
"Penicillin for example, if someone has a potentially life-threatening allergy to penicillin it would be awfully good to know about that before you start to administer anti-biotics in a life-threatening situation. It’s that kind of thing that can make a real difference.
"Computerisation is already happening, but this is about sharing a few items of critical information."
Most patients will of course be conscious, in which case doctors will be required to ask permission to access the new database. But Dr Payne believes this also has the potential to improve care by cutting out human-error and making the information more reliable.
This is expected to speed up treatment and avoid adverse reactions and side-effects.
He added: "The default position at the moment would be to ring the GP surgery and speak to someone...
"Firstly convince them who you actually are and that you have a legitimate interest in that information, and then see if you can have the information from the records communicated to you, and that takes time."
At weekends in particular, it can be difficult for hospital staff to reach information, Dr Payne said, though the GP out-of-hours service can be alerted to particular patient issues. The scheme, which has already been rolled-out across much of England, will be introduced in Bucks over the next 12 months, at a cost of about £200,000.
Every GP-registered patient has been sent a letter to explain the new system, including an opt-out form for patients to return if they do not wish to be included on the database.
Access to the database is restricted to staff who are involved in a patient’s treatment, using a chip-and-pin NHS smartcard. Unlike paper records, an audit trail is generated when a record is viewed.
This has all been a long time coming, but there are strong arguments to be made over extending the database further. Summary Care Records were just one part of a wide-ranging £11 billion programme launched in 2002 to modernise the way the NHS uses and stores information.
But the controversial National Programme for IT in the NHS [NPfIT] was hit by a series of problems and delays, which meant much of the ‘original vision’ was never realised. In 2010, Summary Care Records were suspended in some places after the British Medical Association, a doctors’ union, warned the changes were happening too quickly and not enough patients were aware of them.
And elements of the national press also raised fears about privacy - suggesting NHS staff might use the database to ‘snoop’ on patients. But the real downfall of the NPfIT was its failure to deliver Detailed Care Records.
These would have gone much further than Summary Care Records by including full details of patients’ medical history and treatment.
In 2011 the National Audit Office published a damning report which said the Department of Health had ‘fundamentally underestimated’ the scale and complexity of the project.
It added: "The NHS is now getting far fewer systems than planned despite the Department paying contractors almost the same amount of money..."
The Government later dismantled the outstanding elements of the project. There are now no plans to extend the national database to include things like medical history, though patients are able to request that extra information be added to their files.
Dr Payne said: "Clearly the more information that’s available to the treating doctor the better the outcome is likely to be for that patient...
"Ideally that doctor would like to be able to know past medical history, what significant illnesses they’ve had, as well as what medication they’re on and things like drug intolerances and allergies as well.... Many people seem to think that happens already.
"That would be the ideal but we have to take the public with us on that and clearly there have been concerns about confidentiality around information and I understand that.
"How you ensure that people would only access the information they need to access would be quite challenging. So I think we are a long way off that, and this isn’t a planned step in that direction."
- A Summary Care Record is an electronic record which contains information about the medicines you take, allergies you suffer from and any bad reactions to medicines you have had.
- Healthcare staff have to ask your permisiion to access your record, except in certain circumstances, for example if you are unconscious.
- You can opt-out of the scheme by returning the freepost form sent to you in the post, within 12 weeks from the date of the letter. Additional copies of the form can be obtained at your GP practice or by calling 0300 123 3020.
- If you do nothing the NHS will assume you are happy with the changes and create a record for you over the next six to 12 months.
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