A consensus seems to be growing that a central 'Spine' of electronic patient records is insecure, possibly illegal and crash-prone. It might be OK, perhaps, for summary records, which show allergies but not much else. But even the Summary Care Record, which works along these lines, has after seven long years so far been rolled out to only 370,000 patients.
So, it will be decades, if ever, before a comprehensive national electronic record system could be introduced, even if everybody were in favour, which they demonstrably aren't. And the Tory party will stop it when they win the general election. So forget about a central national database of patient records.
The result is that if you live in Wimbledon and fall under a bus in Newcastle, you will have had it. Actually, it is worse than that. If you live in Tooting and fall under a bus in Kingston, you will have had it too, because Kingston is covered by a different hospital trust, so Kingston will have difficulty accessing your records.
If there is not going to be a national ECR database, the debate should have moved on to where patients' records be held instead. The alternatives are hospital trusts, primary care trusts, GPs or the patients themselves.
The Conservatives have suggested that the patient runs his or her own Google or Microsoft health record. It would indeed be nice, as a patient, to have total control of my record, but I would not trust other patients not to create fantasy records. And of course, the majority of really sick patients would have difficulty in creating and maintaining a coherent record.
Furthermore, data standards would have to be very tight so that the patient record can link to the GPs and hospitals. GPs and hospital doctors might have problems exporting data into the patient record. And who wants to entrust Google or Microsoft with their most personal details? Overall, not a good idea.
Some people say that the records should be held 'locally', without explaining what they mean by local. If that means hospital trusts, this is a bad idea. Hospitals are just one stage of the care pathway. You may remember, back in January, that the anaesthetist at 'Fastrack' Hospital wanted information about a heart murmur from my regular hospital before he would sanction an operation. He was not happy with the information he received, and called for an echocardiogram at a local private hospital – at immense cost to the NHS.
Last month I had an annual check-up with a cardiologist at my regular hospital. He called for another echocardiogram – at more expense to the health service – and was quite unaware of the January echocardiogram, or indeed that I was getting specialist treatment from Fastrack Hospital. Why should he be? Hospital doctors live in little boxes.
Another option is the GP. I am always very impressed by the way my GP surgery keeps my record, using Emis software. All the doctors navigate through my data at the speed of light. And once, two years ago, when one of them sent my wife off to the local hospital's A&E following an angina attack, the doctor selected and printed all the computer records about her cardio-thoracic treatments for the last 15 years in about five minutes, which we took with us to the hospital.
At the other end, the hospital doctor was amazed at the comprehensiveness of the info. She had never been presented with such a clear back-history. My mind boggled. If a consultant in a major teaching hospital found this extraordinary, I realised how deep in primeval gunge NHS records must lie.
So, GP records are better than hospital records, but the snag is that not all GP surgeries are as paperless as mine. Danny Bradbury's report on patient records in Canada shows how hard it can be to implement patient records across a community of independent GPs. The NHS's GPs are probably more disorganised and stroppy than Canadian ones. So it would be a nightmare to impose a workable, secure and standard national ECR on GPs.
An alternative 'local' solution would be to make primary care trusts the hosts of a decentralised national ECR. But I doubt whether PCTs have the right IT skills. And they would need massive funding. So, that won't work either.
So I can offer no answer. All alternatives have fatal flaws. But I am just a humble geriatric patient. Surely, there are a lot of clever fellows somewhere in the NHS who can help. I do wish they at least start a serious debate on where to hold my record. They should have started such a debate in 2002, when the NPfIT was dreamt up, rather than just sniping negatively at the Spine, which is all they have done ever since.
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