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One of the most sensitive issues in health is electronic access to patient data. In England, the debate centres on the Summary Care Records (SCR) to which NHS Connecting for Health wants GPs and other medics to have relatively easy access.
Many doctors are wary, according to surveys. But a more positive outlook has emerged in the first two pilot areas to introduce SCRs, Bolton and Bury Primary Care Trusts. Having started in spring 2007, their respective schemes are up and running, with Bury's being fully operational across all GP surgeries and direct points of patient care.
Carrie Dierden, a spokesperson for Bury PCT, told Smarthealthcare.com that the trust has topped the 100,000 record milestone recently and that doctor's reactions to having ready electronic access to patient data was quite positive.
Plans call for around 140,000 SCRs, around 73% of the local population, to be live on the trust's database in the next few months, with the data accessible to Fairfield General's A&E Department, the Bury Walk-in Centre and Bardoc, the Bury and Rochdale Doctors on Call service. Other sites will be brought on-stream to the Bury PCT SCR database later this year.
All patients have to give their express consent to their SCRs being accessed by doctors although, where a patient is unable to give consent, such as through being unconscious, the medic can access the data when it is in the patient's best interests.
To prevent anything untoward happening, Bury PCT has implemented an audit procedure that is independently monitored. This audit model is being watched closely by other PCTs and interested parties. Patients can also get secure access to their SCR data through the HealthSpace website.
Dr Robert Jeeves, a local GP and clinical lead for the trust's SCR project, says there are substantial benefits to having an SCR. "For the patient, an SCR can improve the safety and quality of their treatment, so helping people to receive the best possible care," he says, adding that, for healthcare professionals, SCRs allows quick access to reliable information when and where it is needed.
Emergency access
At Bury's Fairfield General, emergency staff have become among the first in the UK to get electronic access to patient data at the point of care. This is particularly useful, officials say, if patients are confused and cannot remember the names of all of their medications or if they are unconscious and unable to speak to doctors.
Dr Kassim Ali, Bury PCT's A&E consultant, says that since staff have been able to view SCRs at Fairfield, they have found it useful in making clinical decisions on some of our patients. "Previously someone could be admitted into A&E in an unconscious state with no way of telling us what medications they are on, or if they have any allergies of which we need to be aware. This could mean that we would have to spend time phoning up their GP, but in A&E this is not always practical especially at night and weekends," he says.
"Now, at the touch of a button, we can access this information. The system is easy to access and has the potential for further development to include summary of significant medical history such as diabetes, asthma and other chronic medical conditions," he explains.
Doctors on call at the Bardoc operation in Bury also have access to patient's SCRs through the use of an auditable smartcard system. The smartcard system is controlled by out-of-hours centre supervisors, who allow specified clinicians to view the specific records of patients who are being treated/registered during an out-of-hours session.
Bury GP Dr Zahir Mohammed says he was pleasantly surprised at the quality of information made available and its slick presentation. "Having this information to hand enables us to deliver effective urgent healthcare," he explains.
Bardoc medical director Dr Rob Stokes says the SCR developments will be extremely helpful in bridging hospital and GP services, so that information flows in step with each patient's onward referral. It also means, he added, that his team should find it straightforward to comply with the NHS Number programme.
Caution in Bolton
Bolton PCT, meanwhile, reports that SCRs have been a success, although GP surgeries within the PCT's area are working on three distinct IT platforms, only two of which have been enabled for SCR access. No timescales have been set for the third GP IT platform to be SCR-enabled, according to spokesperson Veronica Swinburn.
Interestingly, whilst Bury's medical staff are effusive in their support for the SCR scheme, Bolton remains cautious, mainly because of the patient consent issue.
The consent model, says Swinburn, has been a difficult issue. "But now, if the patient is conscious, we try to get consent, and it is in the patient's interest," she explains.
It's clear that, once medical staff have experienced the convenience of point-of-care access to SCR data, they are positive about the improvement in patient care. And from the evidence of Bury and Bolton, provided sufficient audit safeguards are implemented as is happening at the two north-western PCTs, then any public worries can be assuaged.
With four more areas already introducing SCRs, and 17 more planning to start by the end of March, it will soon be clear as to whether that success can be extended across England.
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