- "The SCR was based on an unresearched and unverified need."
- It will be "next to impossible to keep SCR database accurately synchronised"
Roz Foad, an NHS informatics expert, has responded to the excellent report by Trisha Greenhalgh and University College London on the NPfIT summary care record scheme.
Foad is chair of the BCS Primary Health Care Specialist Group, and former IM&T Service Manager at Hertfordshire PCT.
"What has not been examined to date are the alternatives to pushing data into a single database.
"The most accurate and complete records kept on a patient are those held by the GPs. The move of all the clinical system suppliers to enterprise systems and storage makes records potentially available 24/7 from anywhere with an N3 connection.
"Patient access to their own GP held records is already available to 70% of the population, with the other two clinical system suppliers working on providing the same. Patients could give access to any clinician needing to treat them outside their home practice.
"Data would include their past history, allergies, alerts and medication and could be viewable in out of hours, extended hours and urgent and emergency care.
Next to impossible to keep SCR accurately synchronised?
"Why create a vast database of extracted excerpts, which will be next to impossible to keep accurately synchronised, when direct access to the full record (or the necessary parts of it) will achieve the goal of providing the right data at the right time at the point of care.
"This also removes the concern over the State having access to patient records, since records would remain under the control of those entering the data; system suppliers would look after storage; and patients would give consent before any viewing.
"Secondary care data gets fed into GP records to add to their completeness. With the forthcoming 48 hour electronic discharge summary this should cover most needs. For special cases such as renal patients needing instant results, access to a portal web page pulling in both secondary and primary care data would suffice. in such cases, data are not extracted and stored, merely viewed, that viewing is recorded, and then switched off.
SCR based on unresearched and unverified need
"The SCR was based on an unresearched and unverified need. The two Greenhalgh reviews have revealed the errors in this approach. The public by and large do not see the need for this and are concerned about security. That is, if the information campaign had reached them at all - for most of them are still unaware of its existence or proposed roll out.
If there is to be yet another review, then it needs to research what is already out there and working, and to identify savings that could be made by using existing technology. It must be completely objective, rather than being used to justify current policy.
Full UCL report on Summary Care Record - UCL website
SCR evaluation finds few benefits - E-Health Insider
Adoption and non-adoption of a shared electronic summary record in England: a mixed-method case study - BMJ
Police investigate smartcard security breach as SCR is launched in London - IT Projects Blog
Roz Foad - Linkedin profile