Dear 'Patient from Hell',
In response to the article in SmartHealthcare.com on becoming 'spineless', I wanted to write with some reassurance, but please note that I am speaking in a personal capacity, not as a representative of PHCSG or UKCHIP. However do check out the websites for details of what we do, for further reassurance!
GP records are indeed very much better quality, and more complete than hospital records, and the only cradle to grave records in the country. The reason for this is that GPs feel that they have developed their systems, they were mostly written by GPs for GPs and there is great loyalty to them.
They contain information on details of all your consultations, surgery appointments, your laboratory results, vaccinations, discharge summaries about your hospital treatment, medications past and present, allergies, adverse reactions, ECGs, Xray results, care pathways, contact with community services, referrals and more.
They act as an information source to clinicians seeing the patient for the first time, and as an aide memoire when reviewing patients. They are coded, so that searches and reports can be run across virtually any item recorded. GPs and their staff also maintain them well because they are paid according to the quality of the data in there for certain long-term conditions.
There are four main GP clinical system suppliers plus a couple of smaller ones and believe it or not, these suppliers are talking to one another on exchanging records between each other. We need the infrastructure of the Spine to pass records from one GP to another when you move. Over 500,000 of these transfers have already taken place.
We will also need it for electronic prescribing, so that your prescription can be sent straight to the pharmacy you chose, so there is less chance of an error in dispensing. If you have a lab test done at the local hospital, this will be electronically transferred into your GP system (it doesn't even need the Spine for that) within a matter of hours. It is hoped that discharge information will reach your GP in the same way before too long.
I note that your GP uses the Emis clinical system, used by 56% of the country's GPs. From my knowledge of the company, I can tell you that Emis has now developed an enterprise system, Emis Web, which can be accessed from anywhere with access to the NHS's own intranet, N3.
In a couple of years, when this is rolled out, you will no longer need to turn up at your local hospital with a GP printout. Your local hospital will be able to securely pull up a summary of your patient record (after you have given consent, unless unconscious, when there is an override with audit trail) and know your background and all the information they need to treat you. This is already happening in pilot sites in the UK. They can fill in a template which will feed information back into the GP system. The other suppliers are working on exchanging data with this system, and are advanced in developing their own.
In the same way, if you need access to care outside normal surgery hours, your surgery phone will direct you to an 'out of hours' service. The doctor there will be able to pull up details of your previous treatment to care for you safely, and feed back what they have done into the GP system, ready for your next appointment. This is already happening in parts of the country.
Your GP will be able to access your secondary care record details which the hospital has submitted to the Department of Health for payment, thus viewing your entire pathway through care. The second biggest GP system, In Practice Systems, has now signed a contract to exchange data with Emis Systems, so that 80% of the country will be able to use these facilities. Of the other two systems, one is in discussions with the big two, and the other has a different coding system, which has its own problems, but is now more open to co-operation.
On top of this your surgery can, if it wishes, offer you on line re-ordering of your prescriptions, booking your GP appointments, a way of sending messages to your GP, and a means of accessing your records from anywhere in the world. They may not have actioned all of these yet, because there are changes to practice management arrangements to get patients and staff able to run these. Other suppliers will be producing their equivalent modules.
You may have heard the press talking about Google Health or Microsoft HealthVault as an alternative to the summary care record. This was not in the Independent Review of NHS IT recently published, nor part of the Conservative's plans, they just said they would look at it, but it would not be an effective replacement for the SCR.
There is a place for patients to view their records and enter comments, but the record used by clinicians for decisions about your treatment needs to be created and maintained by them. Anyone could store their information on these databases if they so wished, and access them from anywhere with an internet connection, but I personally would think twice before giving my personal medical details to an American company which might have to disclose them to the US security forces.
So there will be alternatives to the national database – rather than the infrastructure to send messages, don't confuse the two. Pulling data from existing systems to a display on the screen, which is not saved when you log off – but an audit trail will record what you have seen – rather than pushing data into a central 'bucket' could be another way of achieving the objectives of data where it is needed, when it is needed, to treat the patient. The outcome of the next election may decide which route is taken.
I hope this has done a little to answer your article, I obviously cannot list everything that is happening, especially the consent and confidentiality issues which are being worked through, but thought you deserved an update?
With all good wishes,
Roz Foad MSc MBCS CITP
Chair BCS Primary Healthcare Specialist Group (www.phcsg.org.uk)
Director of Registrations, UKCHIP (www.ukchip.org)
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