Clinicians may not access summary care records - today's UCL report

An evaluation of the summary care records scheme by researchers at University College London has concluded that:

“Benefits of centrally-stored electronic summary records seem more subtle and contingent than many stakeholders anticipated, and clinicians may not access them. Complex interdependencies, inherent tensions, and high implementation workload should be expected when they are introduced on a national scale.”

BMJ summary of UCL report: 



The benefits of the Summary Care Record (SCR) scheme, introduced as partof the National Programme for IT (NPfIT), appear more modest thananticipated, according to a study published on bmj.com today.

Thefindings are based on an independent evaluation by researchers atUniversity College London and come as the new coalition governmentannounces a reviewof the scheme.

The Summary Care Record is an electronicsummary of patient medical records accessible over a secure internetconnection by authorised NHS staff. In 2008, the English governmentbegan to roll out the scheme nationally with the aim of improving thequality, safety and efficiency of care, especially in emergencysituations.

But the scheme has proved controversial with a rangeof alleged benefits and drawbacks, from better clinical care and fewermedical errors to high costs and threats to confidentiality.

Researchersset out to evaluate the scheme over a three-year period (2007-2010).They analysed data across three sites, including over 400,000 encountersin participating primary care out-of-hours and walk-in-centres and 140interviews with policymakers, managers, clinicians and softwaresuppliers involved in the scheme.

By early 2010, 1.5 million SCRshad been created, but the researchers found that creating SCRs andsupporting their adoption and use was a complex, technically challengingand labour-intensive process which occurred much more slowly thanoriginally planned.

In participating primary care out-of-hoursand walk-in centres, they show that an SCR was accessed in 4% of allencounters and in 21% when an SCR was available. These figures wererising in some but not all sites.

Individual clinicians accessedavailable SCRs between 0 and 84% of the time. This varied considerablydepending on setting, the type of clinician and their level ofexperience.

When accessed, SCRs seemed to support better qualitycare and increase clinician confidence in some encounters. There was nodirect evidence of improved safety, but findings were consistent with apositive impact on preventing medication errors.

The researchteam found that SCRs sometimes contained incomplete or inaccurate data,but they did not see any cases where this led to harm because cliniciansused their judgement when interpreting such data and took account ofother sources of information. SCR use was not associated with shorterconsultations, nor did it appear to reduce hospital admission – benefitswhich were anticipated by policymakers.

The evaluation alsoshowed that successful introduction of SCRs required collaborationbetween stakeholders from different worlds, with different values,priorities, and ways of working. The authors say that these differencesmay have accounted for many of the misunderstandings and frictionsoccurring at the operational level. And they suggest that theprogramme’s fortunes will depend on the ability “to bridge the differentinstitutional worlds of different stakeholders, align their conflictinglogics, and mobilise implementation effort.”

They conclude:”This evaluation has shown that some progress has been made inintroducing shared electronic summary records in England and that somebenefits have occurred. However, significant social and technicalbarriers to the widespread adoption and use of such records remain andtheir benefits to date appear more subtle and contingent than earlypolicy documents predicted.”

In two accompanying papers, alsopublished on bmj.com today, experts debate whether summary care recordshave the potential to do more harm than good. Mark Walport, Director ofthe Wellcome Trust believes that the national electronic database ofpatient records will make valuable contributions to better care, butRoss Anderson, Professor of Security Engineering at the University ofCambridge, argues that it is both unnecessary and unlawful.

Links:

UCL paper -BMJ 

ProfessorRoss Anderson – SCR scheme should be abandoned – BMJ

I’m notopting out of SCR – Mark Walport, Wellcome Trust – BMJ

IsSummary Care Record being reviewed because all large IT projects ingovernment are being reviewed – IT Projects Blog

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