Electronic Patient Records

The NHS is creating a shared Electronic Patient Record system for England. The aim is to make treatment quicker and safer by ensuring that health professionals always have access to the information that they need. A national database of medical information could also have massive benefits for research.

However, there are drawbacks. The project has found it difficult to design systems that are suitable for the huge and diverse NHS and is years behind schedule. Many computer experts are concerned that the database opens up new risks to patients’ privacy. And there is still debate about whether patients should get to choose whether their record is made electronic, and if so how the NHS should deal with getting their consent.

There are four main parts to the Electronic Patient Record project:

• Summary Care Records will contain basic information like prescriptions and allergies and will be shared across the whole of England. They will be useful in emergencies and when patients are being treated by people other than their regular doctor.
• Detailed Care Records will bring together more in-depth information from different providers like GPs, hospitals and possibly community carers, so that information can be shared. They will be held at a regional level.
• The Secondary Uses Service makes a record every time a patient receives hospital treatment. These records are used to pay hospitals, but the information about patients is also useful for medical research or monitoring hospitals.
• HealthSpace is a website where patients can view their own record online with a username and password

Frequently Asked Questions

What’s the progress so far?

The National Programme for IT in the NHS was launched in 2002. Since then there have been major delays. The Secondary Uses Service is already up and running across the country. There has also been good progress on the Summary Care Record; around 700,000 people in England already have a record and it’s hoped everyone in England will have one in the next few years. However, very little progress has been made on the Detailed Care Records, which some argue will have the most value in improving care. HealthSpace has been trialled but came to a halt last June. We still do not know whether it will go ahead at all.

What was the system before Electronic Patient Records?

Most GPs and hospitals held records in paper files (and many still do). But in the past few years, a number of GPs and hospitals have introduced their own computer systems to keep electronic patient records locally. Some of these offer new systems like accessing your records from home.

Does everyone have to have an Electronic Patient Record?

Yes and no. Six weeks before a Summary or Detailed Care Record is created, patients should receive a letter in the post. They can then write in or speak to a GP to let them know if they do not want a record. After that 6 weeks, the medical information can be deleted, but only if the electronic record never been used before.

However, it is not possible to opt out of the Secondary Uses Services.

Are patients asked before their Electronic Patient Record is looked at?

Any health professional wanting to access a Summary Care Records has to ask the patient first unless they are unconscious. It is still unclear whether consent will be asked before doctors look at your Detailed Care Record (as they currently do not ask permission to look at your paper files). Patients are not asked or informed when their records are viewed in the Secondary Uses Service.

Will Electronic Patient Records be used for research?

Medical information on the Secondary Uses Services is already being used for research. However, this information is ‘anonymised,’ which means that any information which can be used to identify patients has been removed. However, some argue this is impossible, and even small fragments of information can be used to identify patients.

So far, it is unclear what the procedure will be for using Summary and Detailed Care Records for research.

What’s the use of medical records for researchers?

Having one Electronic Patient Record system for England opens up a massive opportunity for medical research. It will enable scientists to more accurately track diseases and sickness, and to search for connections between two different factors. For example, it would be possible to search for the connection between obesity and death by heart attack, or check how many users of a certain drug have experienced various side effects.

Why would patients want to view their health record online?

It’s hoped that HealthSpace would give patients control of their own healthcare, allowing them to review advice from GP visits and check that their medical information is accurate. In the long term, it was intended that patients would be able to upload information such as blood pressure or lunch capacity from home, saving money and trips to the doctor. However, the NHS claim that the the program has been paused because of the low number of patients in trial areas who chose to view their record.

What will happen if the Tories win the next election?

David Cameron has suggested that, if elected, the Conservatives will abandon the national database in favour of local and possibly private services. It’s not yet clear if this means throwing away what’s already been built or just not building it any further. Some have suggested they might use Google or Microsoft to develop an equivalent to HealthSpace, but so far this has not been an official policy.

What’s going on in Scotland?

The NHS in Scotland has a slightly different system. Scotland’s Emergency Care Summary is similar to England’s Summary Care Record, and it’s already up and running. There is a Clinical Portal, which allows health professionals to view information about a patient which is held in various different databases. There is also a Scottish Health Information Service, which will hold patient information in a central location and be used to monitor and pay hospitals. Patients cannot opt out of this service.

If all the plans are already in place, why are you asking people to give their views?

Although some Electronic Patient Records are already being put in place, the way that they will be used in the future remains very uncertain and the guidance for how records will work in practice is still at a very early stage. There’s plenty of decisions yet to influence.

Where can I find out more information?

E-Health Insider and the Guardian’s Smarthealthcare are both great sites for the latest news on Health IT. If you want to find out more about medical records in your area you can call the NHS Care Records Service Information Line on 0845 603 8510.