Will Summary Care Records do more harm than good?

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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 to accumulate large amounts of data about patients from multiple sources. Many patients' records will start with a hospital discharge summary rather than a general practice summary, while plans are afoot to include medical images and even ambulance messages.

Dangerously incomplete data?

" This rapid increase in scope creates a serious hazard: a multicontributor record for which no individual clinician is responsible. Transfers of data between general practices have thrown up serious difficulties about the different ways in which data are classified.

"Adding other providers will make this worse; experience with the electronic discharge letter suggests that hospital data also vary from poor to dangerously incomplete.

Who'll be responsible for the data?

"In a clinical context, weak controls on quality and consistency may be offset by the effort clinical owners make to organise the data on which they rely. But with no one motivated to curate the data, responsibility for it will be diffuse.

"This is a known hazard in medicine, and applies to other systems too. In no other safety critical system would people just heap up data and hope that someone will deal with it.

"Functionality and clinical autonomy are related to safety. Experience shows that clinical systems bought by doctors generally work, while those bought by civil servants generally don't ...

"It is not surprising that one of the authors of an independent report on the summary care record by University College London, Emma Byrne, has written that the record was "not much use" and "not particularly effective at improving health care."

**

Mark Walport of Wellcome Trust

"I wouldn't dream of opting out of this," says Mark Walport, a director of Wellcome Trust in the BMJ . He adds:

"I am delighted to see progress - eventually - being made towards introducing a joined up system for electronic patient records.

"It is impossible to be a patient or to practise medicine without being frustrated about incomplete and lost health records, difficulty in communications among the extended healthcare team, and needless clinical errors and failure to implement best practice guidelines.

Good IT can be transformational

"Good information technology has the capacity to be transformational. I shall never forget the dramatic improvement to the quality of service to patients and staff that followed the introduction of the first x ray picture archiving system in the UK at Hammersmith Hospital.

"As the leaflet makes clear, the summary care record will provide my healthcare team with quicker access to more reliable information that should help my treatment.

"If I go under a bus in Birmingham, the local accident and emergency department will be able to access my records in London to check whether I have any allergies and what drugs I am already taking--information that could be lifesaving.

"The primary purpose of electronic patient records 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 to improve their accuracy; that they will be treated confidentially; that they will be shared between the members of the healthcare team that collectively look after me in primary care and in hospital; and that they will provide a basis for accountability for the quality of my health care.

"In addition I would hope that my records could be linked to "expert systems" that would minimise the chance of treatment errors and maximise the chance of my being prescribed the best treatment.

SCR a huge potential benefit?

"There is another huge potential benefit of a nationwide electronic patient record system, to improve treatment through research. Research provides the evidence that medical treatments work or, equally importantly, that they don't. It is an integral part of the best health systems.

"The foundation for much of this research is information contained in patient records. This information allows us to discover the factors that determine health and disease, to monitor the safety of drugs, and to study the effectiveness of treatments.

"Medical records can also be used to identify patients who might be suitable to take part in a clinical study, in order to invite them to take part...

NHS Connecting for Health has not been marketed well

"The new coalition government, coupled with the economic crisis, means that the future is uncertain for Connecting for Health. I do not believe that Connecting for Health has been marketed well to either patients or the medical profession.

"There has been much too much about its use as a management tool and too little about its primary aim, which should be to improve care. It may be that it would be better implemented as a more federated programme, ensuring common standards to allow interoperability. A key aim must be integration of records and communication across primary and secondary care.

"But one thing is certain - the best care requires the best medical records. A world class NHS demands a world class infrastructure. The future for medical records is digital."

Links:

Summary of today's Care Records Service report - BMJ website

Long-awaited SCR report reveals insoluable problems - Pulse

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

SCR evaluation finds few benefits - E-Health Insider

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