It is piloting palliative care summaries, developed from those used by Macmillan cancer nurses, in the Lothian and Grampian health board areas.
These will include a clause, which is optional for the patient to use, that says whether the patient wishes to be kept alive in various extreme medical circumstances.
NSS is explaining the plan to GPs and has prepared leaflets for patients. The system is technically available across Scotland, but its usage will be rolled out over the next few months.
Dr Libby Morris, chair of the Emergency Care Summary board, said that NSS expects about 20 participants each year for each average 5,000 patient GP practice. The records will be added only with patients' explicit consent, and can include their wishes on the circumstances in which they would or would not want to be resuscitated.
"In my own practice, I feel one of the limits is calling it a palliative care summary," she told an audience at the e-Health Insider conference in Birmingham on 9 November 2009. "They then say, I didn't think it was that bad." An alternative name may be a special summary, she added.
Morris said that Scotland now has 5.4m ECS records, more than its 5.2m population as it retains records for two years after death. The system, which draws data from GP systems twice a day, is shunned by just 1,400 patients, 0.02% of the population.
NHS staff ask patients for permission to access the record on every occasion, unless the patient is unconscious or otherwise incapable. "It's just a matter of politeness and good manners," she said. Patients agree their records can be accessed in 99.3% of requests.
Morris said that the information security breach of paper records in Fife last year had actually boosted the use of ECS, rather than causing patients to opt out. It caused a GP practice that thought it was participating but had accidentally switched off its connection to realise this, and reconnect as a result.
ECS is available to out of hours providers, operators of Scotland's NHS24 health helpline and staff at accident and emergency wards. The Scottish Ambulance Service is piloting ECS access in the Lothian health board area, and access for planned hospital admissions is under consideration: Morris said that at present A&E often gets better data on patients than wards for scheduled care, as referrals from doctors may have been written several months ago.
She said that the system might eventually develop into a central record of all medications, but it currently holds acute prescriptions from the last 30 days and repeat prescriptions from the last year.
Morris said the system has proven its worth through cases such as a 62 year-old woman who was admitted to hospital and had not mentioned she needed insulin – as she was hooked up to a drip, she assumed staff already knew. It also helped a 17 year-old who was taken to A&E unconscious after an overdose. His ECS showed he was not on any medication, but his father who brought him in gave permission for access to his own record – which showed the drug in question.
