Will Summary Care Records do more harm than good?

The Summary Care Record must be abandoned for reasons of safety, functionality, clinical autonomy, patient privacy, and human rights, says Professor Ross Anderson of Cambridge University.

He also says today that the SCR “brings very few benefits and has the potential to do serious harm”.


Ross Anderson, professor of security engineering at the University of Cambridge Computer Laboratory, argues that the national database of national electronic database of patient records is not fit for purpose and illegal.

In the British Medical Journal his arguments go head to head with those of Mark Walport, a director of Wellcome Trust, who believes that the SCR will make valuable contributions to better care.

Their arguments come as a final report of University College London’s evaluation of the summary care record scheme is published. A summary of the report is on the BMJ’s website. 
 
Anderson says that a digital medical record system that shared information when appropriate between care providers, and was dependable and safe, would be of “great value”. He adds:

“However, the summary care record isn’t it. It must be abandoned – for reasons of safety, functionality, clinical autonomy, patient privacy, and human rights.


“… The truth is that the summary care record was designed toaccumulate large amounts of data about patients from multiple sources.Many patients’ records will start with a hospital discharge summaryrather than a general practice summary, while plans are afoot to includemedical images and even ambulance messages.

Dangerouslyincomplete data?

” This rapid increase in scope creates aserious hazard: a multicontributor record for which no individualclinician is responsible. Transfers of data between general practiceshave thrown up serious difficulties about the different ways in whichdata are classified.

“Adding other providers will make thisworse; experience with the electronic discharge letter suggests thathospital data also vary from poor to dangerously incomplete.

Who’llbe responsible for the data?

“In a clinical context, weakcontrols on quality and consistency may be offset by the effort clinicalowners make to organise the data on which they rely. But with no onemotivated to curate the data, responsibility for it will be diffuse.

“Thisis a known hazard in medicine, and applies to other systems too. In noother safety critical system would people just heap up data and hopethat someone will deal with it.

“Functionality and clinicalautonomy are related to safety. Experience shows that clinical systemsbought by doctors generally work, while those bought by civil servantsgenerally don’t …

“It is not surprising that one of the authorsof an independent report on the summary care record by UniversityCollege London, Emma Byrne, has written that the record was “not muchuse” and “not particularly effective at improving health care.”

**

MarkWalport of Wellcome Trust

“I wouldn’t dream of opting out ofthis,” says Mark Walport, a director of Wellcome Trust in the BMJ . Headds:

“I am delighted to see progress – eventually – being madetowards introducing a joined up system for electronic patient records.

“Itis impossible to be a patient or to practise medicine without beingfrustrated about incomplete and lost health records, difficulty incommunications among the extended healthcare team, and needless clinicalerrors and failure to implement best practice guidelines.

GoodIT can be transformational

“Good information technology hasthe capacity to be transformational. I shall never forget the dramaticimprovement to the quality of service to patients and staff thatfollowed the introduction of the first x ray picture archiving system inthe UK at Hammersmith Hospital.

“As the leaflet makes clear, thesummary care record will provide my healthcare team with quicker accessto more reliable information that should help my treatment.

“IfI go under a bus in Birmingham, the local accident and emergencydepartment will be able to access my records in London to check whether Ihave any allergies and what drugs I am already taking–information thatcould be lifesaving.

“The primary purpose of electronic patientrecords is to improve patient care. As a patient I expect the following:that my records will be accurate and that I can work with my carers toimprove their accuracy; that they will be treated confidentially; thatthey will be shared between the members of the healthcare team thatcollectively look after me in primary care and in hospital; and thatthey will provide a basis for accountability for the quality of myhealth care.

“In addition I would hope that my records could belinked to “expert systems” that would minimise the chance of treatmenterrors and maximise the chance of my being prescribed the besttreatment.

SCR a huge potential benefit?

“There isanother huge potential benefit of a nationwide electronic patient recordsystem, to improve treatment through research. Research provides theevidence that medical treatments work or, equally importantly, that theydon’t. It is an integral part of the best health systems.

“Thefoundation for much of this research is information contained in patientrecords. This information allows us to discover the factors thatdetermine health and disease, to monitor the safety of drugs, and tostudy the effectiveness of treatments.

“Medical records can alsobe used to identify patients who might be suitable to take part in aclinical study, in order to invite them to take part…

NHSConnecting for Health has not been marketed well

“The newcoalition government, coupled with the economic crisis, means that thefuture is uncertain for Connecting for Health. I do not believe thatConnecting for Health has been marketed well to either patients or themedical profession.

“There has been much too much about its useas a management tool and too little about its primary aim, which shouldbe to improve care. It may be that it would be better implemented as amore federated programme, ensuring common standards to allowinteroperability. A key aim must be integration of records andcommunication across primary and secondary care.

“But one thingis certain – the best care requires the best medical records. A worldclass NHS demands a world class infrastructure. The future for medicalrecords is digital.”

Links:

Summary oftoday’s Care Records Service report – BMJ website

Long-awaitedSCR report reveals insoluable problems – Pulse

Highlightsof draft summary care records evaluation [similar to final report] -IT Projects Blog

SCRevaluation finds few benefits – E-Health Insider

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