Thursday, March 24, 2011

Here is A Model of a PCEHR That Makes A Lot More Sense Than the NEHTA / DoHA Plan.

The following appeared a few days ago:

Quarter of practices link to Welsh SCR

21 March 2011 Fiona Barr

More than 25% of GP practices in Wales are now feeding information into the country’s summary record via INPS’s Vision 360 data sharing solution.

INPS said it is streaming information from GP practices’ Vision 3 systems into its central Vision 360 repository to provide clinicians working out-of-hours with access to the Individual Health Record, Wales’ version of a summary record.

The company said communities now using Vision 360 include Pembrokeshire and Ceredigon, Aneurin Bevan and Cardiff and Cwm Taf, which between them have made 750,000 records available in the Vision 360 Patient Summary IHR.

There have been about 6,000 accesses to the IHR in the last 12 months using Vision 360, and INPS said accesses are currently running at about 700 views per month as more practices come on board.


The NHS Wales Informatics Service announced last October that it had signed contracts with four suppliers – EMIS, INPS, iSoft and Adastra – to deliver the IHR across the country.

The IHR contains information on medications, allergies, adverse reactions, current problems and diagnoses and test results and is designed to be viewed in out-of-hours services with patient consent.

More here:

Now what is interesting about this shared record is revealed in the following earlier report.

Welsh GPs put conditions on IHR

20 December 2010 Fiona Barr

GP representatives in Wales have listed a series of safeguards that they want to see implemented before Individual Health Records are uploaded.

The BMA’s Welsh General Practitioner Committee said it was “supportive” of the emergency summary record system in Wales but wanted to see explicit confidentiality safeguards.

The committee’s six-point list of requirements is: a public information campaign before roll-out in any area; an absolute right for patients to opt-out at any time; explicit consent to view that applies only for the duration of a consultation and is obtained directly by the clinician carrying it out; and access restricted to clinicians involved in the direct care of the patient.

Dr David Bailey, chairman of the Welsh GPC, said: “Because it is a prĂ©cis of the GP record, we feel that access must be restricted to clinicians only - by which we mean doctors and nurses involved in the direct care of the patient.

“Explicit consent to view should be restricted to the time and for the purposes of the consultation only and not extended to allow access subsequently, even for audit purposes. Explicit consent to view should be obtained from the patient by the consulting clinician.”

The IHR has been running in Gwent since 2007. This year it was introduced in Pembrokeshire and parts of North Wales. And it is currently being piloted in Cwm Taf and Cardiff.

The BMA said Welsh government policy was to roll-out the IHR across the whole country over the next 12 months, but it pointed out that GPs practices needed to consent to the uploads.

The IHR contains patients’ demographic data, medications, significant medical history, Read codes of the most recent consultations, allergies and recent test results.

It is designed to be available to clinicians in hospitals and out-of-hours services.

More details here:

So the features are:

1. A shared summary record designed to be used by clinicians involved in direct patient care - not patients.

2. Patient Control at point of record being sent to central store and patient required to consent for non-regular carer to view record. Obviously the usual care team has the full record.

3. Clarity that there is one primary record - the one held by the practitioner in their system and the IHR is a copy and a copy only. Ownership (and blame) is clear!

4. No concept of the record being a longitudinal record - it is purely an acute care summary to assist with emergent care.

5. No patient contribution to the record - i.e. responsibility for record contents is clear and unambiguous. (If they want a PHR they can set up their own.)

6. Defined and limited data set with each feeding system using a common data model for the basic items and coding.

7. Automated upload of consented records each evening so essentially zero effort and workflow impacts of a basic summary system being in place.

You can read more here:

While there are still to be any evaluations of this type of system that provide proper evidence that such systems make a difference it seems possible that a simple, clearly thought out model such as this gets as close as possible to be likely to be useful.

My view is that if the Government wants to press on with the PCEHR a model of this sort might be worth a very close look as I reckon what they are currently on about is a real dud!


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