BMA issues new guidance on NHS CRS

The BMA Chairman has written to all BMA members to provide them with guidance on the NHS Care Records Service and outlining what it means for doctors and their patients.

Although Connecting for Health is due to begin an expensive public information campaign, the BMA says it believes that patients should be made aware now of how the new system will hold and share information about their health and medical appointments.

In a letter to the medical profession, James Johnson, chairman of the BMA, tells doctors that the NHS Care Records Service will bring significant changes to the way patient healthcare information is recorded and accessed in the NHS.

Mr Johnson said: “The BMA would like patients to be able to make a positive informed decision to share their medical records if they feel that is right for them. This type of approach will have the added advantage of providing an opportunity for both doctors and patients to check the accuracy of the information before it is shared.

“Patients will need to make important decisions about who can access their health information. People with medical records containing information about unwanted pregnancies, mental illness and HIV status in particular, will need to be reassured that they have the right to keep this information between themselves and their doctor.

Mr Johnson added: “There has already been considerable publicity on the new health record, and until Connecting for Health puts in place a comprehensive public information campaign, we would advise doctors to start discussing the implications of introducing the new system to protect the confidential nature of the doctor/patient relationship at the heart of modern medicine.”

In accompanying guidance sent to all doctors ‘Connecting for Health – the NHS Care Records Service in England’ the BMA outlines NHS CRS , the central component of the health service digitization project, together with stating where appropriate the BMA’s policy position.

"The BMA supports, in principle, the concept of an integrated centralised health record system", but says there are important decisions that patients have to make. "Patients need to be properly informed and enabled to make informed choices".

As well as explaining that NHS CRS is planned in two parts "summary" and "detailed" the BMA guidance stresses that the change will have a huge impact on doctors and the way they work as paper records are gradually "phased out"

"Healthcare information you record may be accessed by other healthcare professionals in England, subject to the patient’s agreement. This will have implications to the way you record information."

In what the BMA says will become a series of guidance notes on NHS Connecting for Health the medical profession’s union says; "Connecting for Health will significantly impact on your working practices and therefore it is important that you are fully informed of developments."

The guidance stresses that it is "very important that you share this knowledge with your patients so that they can make appropriate informed choices about how their information is stored and shared".

Patient consent is the main point on which the BMA is directly at odds with CfH policy. "It is BMA policy that patients should give explicit consent before any healthcare data is uploaded onto the spine – i.e. they should specifically opt-in to the system."

"In contrast, CfH policy is that patients should be deemed to have given implied consent to sharing their healthcare information between relevant clinicians unless they specifically opt-out. Healthcare information will be shared, in this way, unless a patient informs a healthcare professional they do not wish this to happen."

The guidance says that the two positions represent "an important division of views" and strongly urges members to explain to their patients the move to electronic sharing of information "so they can make an informed choice of how they want their information to be shared."

With increased sharing of information will come "a risk to the confidentiality of that information", says the guidance, though it stresses that 100% security can never be guaranteed with any system, "even with the existing paper-based system".

Turning to the security measures that will protect patient confidentiality the guidance says that these will include smart cards, legitimate relationships, role-based access, sealed envelopes and audit trails and alerts.

The authors acknowledge though that only one of these elements has actually been built yet. "With the exception of smart cards, the BMA has not yet seen these security measures working because the systems are under development". The guidance says that the BMA "has called for an incremental approach and thorough testing and piloting of systems so that the profession can be confident that these safeguards work and doctors can maintain their duty of confidentiality."

Elsewhere the guidance the says that there will be access to CRS outside the NHS, with proposals for pharmacists, dentists and opticians to have access to elements. In addition it notes there are plans for the NHS CRS "to be linked to social care systems".

"The BMA would resist plans for social services having access to health records unless a patient had been explicitly asked for consent," states the guidance.

Advising on when the CRS will happen the guidance says "the deadline for implementing the full NHS CRS is 2010", it notes, however, press reports of delays to CRS. It adds though that work is underway with "almost a quarter of a million NHS staff registered to access the spine and allocated with a smart card".

The beginning of the Personal Demographic Service as part of the spine is also noted as are plans to begin pilots of summary records in 2007.

Links

Letter from James Johnson, Chairman BMA’s working party on IT

BMA NHS CRS Guidance