The rubber has now hit the road as far as rolling out the UK’s Summary Care Records System (SCR) and we are now seeing the inevitable and predicted difficulties.
The following provides a flavour of what is going on
Friday 19 March 2010 09:45
The Summary Care Records database - which is central to the government's plans to create health records for 50 million people - contains inaccuracies and omissions that make it difficult for doctors to trust it as a single source of truth, according to a confidential draft report.
The findings by researchers at University College London, are likely to reinforce the concerns of the British Medical Association which has called for a halt to the "rushed" rollout of the "imperfect" Summary Care Record scheme.
The Government launched Summary Care Records to help doctors and nurses make better clinical decisions. The aim is for clinicians and out-of-hours doctors to have access, particularly in an emergency, to a central record of a patient's allergies, medications and adverse reactions to drugs.
But the researchers at University College, London, found examples where the Summary Care Records central database failed to indicate a patient's allergies or adverse reactions to drugs, and listed "current" medication that the patient wasn't taking.
The database also indicated allergies or adverse reactions to drugs the patient did not have.
Inaccurate information in the central database came from uploads of patient records by GP practices.
Patients unharmed - because doctors didn't trust the SCR database
Researchers at UCL found no evidence that incomplete or inaccurate data on the SCR database had led to patients to coming to harm - but precisely because doctors did not trust the new system as a single source of truth, and took extra time to double-check details of medications and allergies.
No evidence of safer care
The researchers found no direct evidence that the care records system led to safer care, though they said that access to the database may reduce some rare medication errors. There was no clear evidence that consultations between doctors and patients are quicker - and in some cases use of summary care records made consultations longer.
But researchers also found that when central records are accurate, they can be useful for clinicians, particularly when patients are poor at communicating or, if they are on multiple medications, cannot remember what they are.
We also have
23 Mar 2010
GP leaders have joined the attack on the roll-out of the Summary Care Record, calling for an immediate halt to the roll-out and an urgent discussion of the issues with the Department of Health and NHS Connecting for Health.
The BMA’s General Practitioner Committee, which represents all GPs in the UK, passed a unanimous motion saying that "the GPC deplores the recent fast roll-out of the SCR in England.
"We seek the halting of this roll-out and that the DH and CfH discuss these issues urgently with the profession.”
Dr Grant Ingrams, co-chair of the joint IT Committee of the BMA and RCGP, said the general feeling of the GPC was that the roll-out had been “a dog’s dinner."
He told EHI Primary Care: “It’s been pushed through without thinking through the consequences, there is a lot of misinformation out there and there are a lot of primary care trusts and certainly practices who are not really up to speed on the issues.”
The debate at the March meeting of the GPC follows a letter sent by the BMA to health minister Mike O’Brien almost two weeks ago, calling for the SCR roll-out to be suspended.
19 Mar 2010
A confidential draft report from the evaluation of the Summary Care Record says data uploaded from GP practices is sometimes wrong but that the SCR can be useful when the data is accurate, Computer Weekly magazine has reported.
The IT magazine says the evaluation team from University College London found examples of uploads from GP records where there were inaccuracies and omissions in the data on medications, allergies and adverse reactions.
The researchers found no evidence that patients had come to harm because of the inaccurate or incomplete data but said doctors took extra time to double check details of medications and allergies, according to the magazine.
Concerns about the quality of the data uploaded from GP practices has been a theme since the SCR was first devised with GP practices originally incentivised to provide good quality data through an IM&T directed enhanced service which sought to create data ‘fit for sharing’.
Since the DES ended in March last year the quality of the SCR has been reliant on primary care trusts implementing data quality standards which has been criticised by some as providing no “carrot or stick” to practices on data quality.
The draft report from UCL is also reported to say that SCRs can be useful for clinicians if they are accurate, particularly if patients are poor at communicating or if they are on multiple medications and have difficulty remembering them.
Other findings reported are that there was no evidence that the SCR made consultations shorter and that in some cases it made consultations longer. There was also no direct evidence that SCRs led to safer carer although it might reduce some rare medication errors.
The lessons for NEHTA and Australia from all this are legion.
First it is just silly to roll out this sort of thing until you have the quality of the basic patient data in GP and specialist systems really up to scratch. That of itself is a 5-10 year project. The UK had been providing large data quality incentives for a number of years under the banner of ‘data fit to share’ and the data is still flawed. Can you really believe the situation would be even as good here?
Second, rushing implementation of this sort of top down approach will inevitably take time. There is no sense in pushing too hard. Incremental steps are vital.
Third is that the UK has a limited number of different GP systems that have been planned over years to capture the data set required. We are at present nowhere near having that level of standardisation and to get there will take a long time.
Fourth it is clear the evidence supporting the value of a centrally stored shared record is presently not all strong or compelling despite the intuitive view that it is a great idea.
Last there are all the issues identified in the blog of a couple of days ago about consent, information sharing and control, physician trust and so on.
Read closely about the UK lessons so far. This is a path we may not want to sensibly go down without a great deal of thought and care!