Electronic record content still up for discussion

The question of what information will go on a local record and what will go on a national summary record is still open for discussion, a medical conference in London heard last week.

The conference “Challenges for Doctors in the Digital World” was held the day after the launch of the new Care Record Guarantee – the document that sets out the rights and responsibilities patients and the public will have in relation to their health information.

Delegates at were told by deputy chair of the Care Records Development Board (CRDB), Professor Sir Cyril Chantler, that the guarantee was not a finished document and feedback was needed. In particular the board, which is responsible for the guarantee’s development, wanted to hear how it worked in practice.

He listed remaining questions about the guarantee including:

• What goes on a summary record? What goes on a local record? How do they relate? Who sees which?

• What options should patients have to control what is recorded and how it is recorded and where it goes?

He said the CRDB was recommending that people should not be offered the choice to opt out of recording their healthcare data on the NHS Care Record Service – the national record service that will be available throughout England to authorised users with a legitimate reason for accessing a patient’s details. The board is supporting the right to control the sharing of data.

The BMA plans to have an open session on patient confidentiality at its annual meeting next month.

Speaking generally about NHS IT modernisation Sir Cyril said: “I really do think it has the potential to do more for patients than any single development since I qualified 42 years ago.”

The conference appeared to mark a thaw in relations between the BMA and Connecting for Health. Dr John Powell, chair of the health information management committee held out the olive branch saying that the association may have doubts about whether Choose and Book was a clinical or a political decision but, he concluded: “We have to help the NHS implement the most useful and useable system.”

“The BMA had been working hard to establish a relationship with senior figures and I’m pleased this is bearing fruit,” said Dr Powell, admitting doctors had been sceptical about embracing the National Programme for IT.

He urged continuing questioning of developments, however. Systems had to be designed with a proper understanding of how they will be used and followed up with systematic reviews.

“We must always question whether what we are doing is going to support patient care,” he said.

The meeting received an unscheduled visit from NHS IT director-general, Richard Granger who reported that progress on the programme fell into three broad categories: some things running on time; some things running late and some things completed that were not on the books at the start of the programme.

He joked that many systems in the NHS were critical in the sense that one would hear about them if they failed: GPs’ payments were one of these. Implementing the new QMAS system to support the Quality Outcomes Framework was one of the jobs taken on that was not on the books at the start, he said.

“My original script was: go shopping, build, implement,” said Granger indicating he had not bargained for quite so much communication, consultation and redesign work.

However, he said: “We’ve already proved we can deliver quite a few things.”