Wednesday, October 13, 2010

Common Sense Prevails With the UK Shared Electronic Health Record - A Good Thing!

The following appeared a few days ago.

Summary Care Record given go-ahead

11 Oct 2010

The Summary Care Record is to go ahead, but its content will be limited to core information and an opt-out form will be included in patient information packs.

The Department of Health has published the results of two simultaneous reviews of the SCR, covering the content of the record and the information patients receive before their record is uploaded.

The reviews were set up by the coalition government this summer, following concerns about patients’ awareness of the SCR and the kind of information added to it. This had led to the suspension of further patient information programmes.

The review of the content of the record, led by NHS medical director Sir Bruce Keogh, concluded that the core record should only contain a patient’s demographic details, medications, allergies and adverse reactions, and that these should continue to be copied from the GP’s medical record.

The review group said the DH should only consider expanding the content of the record “when we have built trust in the system and when patients request that we should do so.”

Lots more detail here:

http://www.ehiprimarycare.com/news/6308/summary_care_record_given_go-ahead

All I can say is that this is a remarkably sensible set of decisions.

The keys are:

1. The simplest possible record - populated largely with information that does not change all that often or much.

2. Source the information direct from a system that is used by the caring clinician who has an interest in making sure the information is correct.

3. Make sure that anyone who wants to can simply ‘opt out’. (Avoid all privacy concerns at the ground level)

4. Have the information accessible to responsible clinicians for use in what would typically be more emergent situations.

By taking this simple first step you are then in a position to gradually, over time, as public and clinician confidence grows expand what is done, who can access the information and so on.

If NEHTA and the RACGP were working to get something of this ilk going as a first step to their much more risky and expansive objectives I for one would be keen to support the program. Of course I would like to see careful evaluation of a substantially scaled pilot to ensure a national effort was actually going to work and deliver the benefits that appear to be intuitively obvious but for some reason seem hard to actually demonstrate.

Surely we all now know that trying to do too much on a grand scale simply doesn’t seem to work well.

As I have said endlessly success will only flow if we bite of chunks we can actually chew!

As I said yesterday we also have to make sure we consider the impact of all the various different demands on the system providers, and integrate this simple sharing with a secure messaging framework and so on to minimise the change required at the ‘pointy’ clinician end.

If this simple shared record and secure message transfer can be made to work over the next few years then is the time to start considering how a PCEHR might be then added.

To not move slowly and incrementally in a carefully planned and resourced way will be a prescription for failure I believe.

David.

3 comments:

Anonymous said...

David, I agree this is a sensible route. I am, however, surprised you are supporting opt-out. Is there significantly less risk in this core summary record than a full record? What are the dangers of taking consent as implied for future expansions of the information?

Dr David More MB, PhD, FACHI said...

My feeling is that unless you ensure it is easy to not be part of this plan - having explained the consequences - then the risk of is that political and privacy backlash can prevent any real progress.

This seems to be the call other countries have made.

It is a real judgment call however I agree.

David.

Dr David More MB, PhD, FACHI said...

"What are the dangers of taking consent as implied for future expansions of the information?"

On this point it seems to me consultation in the US and Europe seems to suggest at least a significant minority want control on the information recorded at an item level. So the danger is that you destroy trust in the system at least.

David.