(Note - click on images to enlarge)
From the UK comes a really timely warning about the critical need to really move slowly and simply on Shared EHRs and our proposed PCEHR.
1 March 2011 Fiona Barr
Plans to allow hospitals and patients to add to the Summary Care Record have been put on hold as the Department of Health seeks to rein in both the content of the record and who can view it.
A revised scope document for the SCR, published by NHS Connecting for Health, makes it clear that, for the moment at least, information will be limited to details uploaded from GP records.
It says the scope of the SCR needs to be clearly defined “to avoid scope creep, which has the potential to lead to unexpected consequences, clinical safety issues or additional costs.”
The document confirms the conclusion of the DH's review of the content of the record that was published last October and which said initial content should be limited to details of a patient’s medications, allergies and adverse reactions.
The scope document says GPs can add additional information with the patient’s explicit consent, but qualifies this by saying it should only be information that will improve the quality of care provided by clinicians working out-of-hours or in an emergency care situation.
The DH has made it clear that it plans to limit access to urgent and emergency care settings and suspended a planned pilot of access in a community pharmacy, as EHI Primary Care revealed last month.
Two years ago, the DH was drawing up plans for ‘Release 2’ of the SCR. This would have involved staff in A&E departments and other NHS organisations entering data including discharge summarues, outpatient clinic letters and Common Assessment Framework documents.
The plan also included proposals to allow patients to enter their own data via the HealthSpace portal.
Last summer two hospitals, The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust and Pennine Acute Hospitals NHS Trust, were planning to upload non-GP summary data.
However, both have now abandoned those plans. In November, the Information Commissioner’s Office was told that additional feeds from secondary care were on hold.
I have had a look at the scope document and the planned scope of the shared record is now:
----- Begin Extract
2 Scope of the SCR
2.1 Content of the SCR
The SCR is designed to provide a summary of clinical information which would be deemed useful in the event of urgent or emergency care for a patient, particularly when other sources of information may not be readily available. The over arching aim is that the SCR will contain only significant aspects of a person’s care, those deemed to deliver benefit to a patient when receiving urgent and emergency care.
When a patient’s SCR is first created it will contain details of:
• Adverse reactions; and,
This will be copied to the Summary Care Record from the patient’s GP record, under “informed implied consent”.
Following this a patient and their doctor may wish to add additional information to the patient’s Summary Care Record. This must only be added with the explicit consent of the patient.
Any additional information will be selected to allow a greater quality of care to be delivered to the patient by other clinicians who may access the patient’s SCR whilst providing treatment in an urgent or emergency setting. A specific example of this additional information is the inclusion of End of Life Care Plans for patients undergoing palliative care.
An update will be sent to the SCR as information in a patient’s General Practice record is changed, for example, as new medications are prescribed. Each update sent to the SCR is time and date stamped and replaces the information already held. The latest version of the patient’s SCR is the only one available for staff giving care to the patient.
---- End Extract
So here after over a decade’s research trial and work we find what the UK has worked out is practicable and useful - and it is just nothing like the over-engineered and doomed to fail in my view PCEHR.
We have to walk before we can fly and showing a level of competence by getting the very basics in place would be a really good place to start!
The following diagram shows just what is intended by NEHTA - and the scale and complexity just boggles the mind from an organisation that has never actually delivered an operational system to anyone anywhere.
Of course we have seen all this before. Compare this with NSW HealthELink in 2006. Same excessive complexity and over done approach!
Needless to say HealthELink is now a small historical note in the History of E-Health in NSW.
Remarkably many of the flaws in HealthELink (workflow issues, lack of incentives and usefulness) are just the same in the PCEHR.
This is just utter madness! We really do need to take things one step at a time and not let over ambitious engineers ruin any hope for success.