Healthcare assistants' access to SCR defended

Tags: BMA CfH GP GPs Information Governance PCT SCR

04 Mar 2008

Connecting for Health has defended the decision to allow healthcare assistants to access Summary Care Records (SCRs) in accident and emergency departments.

Royal Bolton Hospital’s A&E department has been criticised by BMA IT representative Dr Paul Cundy after a document, released under the Freedom of Information Act, revealed that healthcare assistants are asked to print out SCRs for clinicians.

Dr Cundy, chairman of the BMA’s GP IT committee, told the BBC’s Today programme that such a practice “breaches all common concepts of privacy and confidentiality.”

However, Dr Gillian Braunold, CfH’s clinical director for the SCR, claimed the policy had been approved by the SCR Advisory Group, which includes BMA membership.

She told EHI Primary Care: “Several months ago we looked at A&E departments around the country and took advice from the A&E consultant who is our adviser, to find out how easy it would be for clinicians in A&E to directly access records.

“The answer was that in the majority of cases they would need to have somebody print it out for them. We took that to the advisory group and got their approval for it.”

Dr Braunold said CfH did not dictate to NHS organisations which groups of staff should access records, leaving it to local organisations to decide for themselves following their own information governance procedures.

She added: “The NHS couldn’t function if people at the centre told organisations what roles people should carry out. We’ve tried very hard not to dictate who should be awarded access.”

She said that in her own practice healthcare assistants trained as phlebotomists had access to patient records and that it was common in general practice for receptionists to access records as part of repeat prescribing work. She said it was an “outrageous slur” to suggest that healthcare assistants were equivalent to receptionists.

The row over the Bolton procedures was revealed following a FoI request by Computer Weekly which revealed that the original leaflets sent out to patients on Bolton about the SCR promised that receptionists “will not need to see your full clinical records.”

When GPs in Bolton discovered that receptionists were printing out records for clinicians in the A&E department, they demanded that the PCT write to patients again to tell them of the change in plan. The PCT decided to change the procedures to allow health care assistants to print out the records.

Dr Braunold said the leaflets were being reviewed as part of the early adopter programme and there was no intention to mislead people.

She added: “The problem is you can end up misleading people by giving an example, for example saying a receptionist will not view your full record, rather than saying ‘only people who need to look at your records will do so.’”

Dr Cundy told EHI Primary Care that it was unacceptable for patients to be told that only clinicians would access their record sand then for that position to change within a few weeks of the early adopter site going live.

He added: “Will Gillian Braunold now write to every patient correcting the previously undelivered promise? This whole concept is based on trust and confidence and if promises aren’t delivered then confidence is going to be eroded.”

Dr Braunold said the procedures in Bolton would be reviewed by its own board and that the issue was likely to be discussed at the SCR Implementation Board due to meet this week. She added: “Nobody is trying to do anything wrong. The information governance environment needs to be audited and we are working very hard to make sure that happens. The trouble is there is a highly political agenda which sometimes makes it feel like we are fighting the Battle of the Somme.”

Fiona Barr

Reader's Comments

Printouts

04 Mar 08 09:03

What a farce. £12bn invested in a computerised system of records, smartcards for all clinicians (and everyone else by the looks of it), no doubt hours of training for the doctors - and what do they do when the patient turns up?

Print out the record.

What a farce

stressfreedave@hotmail.com

04 Mar 08 09:03

First of all they allow multiple people to use the same smart card meaning the 'audit trail' will not be of any use in finding out who looked at whos record, now they appear to have decided to lower the standards even further by pretty much having a free for all.

The printing out of the info also fly's in the face of all the PR they have done. The idea of the computer based system was because the paper records were less secure, and now they are using a £12-£20 billion IT system to print out paper records!

(Post edited by EHI)

Heavy weather in the SCR tea cup

04 Mar 08 13:03

With hilarious predictability we're subjected to another round of theatrical brow beating and hammed-up outrage over an aspect of the Summary Care Record. And the cause? Well, because after spending some time, money and effort (but only a fraction of the headline figures) to create SCRs, NHS staff are actually using them to treat patients.

Is anyone interested in whether those staff are finding it useful or helpful? Is it improving the quality of clinical care or possibly even saving a life or two? No, they're too busy foaming at the mouth in self-righteous indignation because there is a slight variation in how it's being used in practice from how they thought it might be used in those interminable planning meetings. How unusual is that?

Storm in a teacup

04 Mar 08 17:03

This is really nothing to do with NPfIT, but all about who needs to use all or part of the medical record. We have all known for ages that many non-clinical staff have access to a greater or lesser degree to paper records - the vast majority of which is both legitimate and necessary - unless we insist on only clinicians pushing beds around hospitals or working out 18-week targets or issues around bed-blocking. We do need to be more transparent about it - can anyone seriously suggest that this is anything new and a problem with NCRS? The phrase 'a receptionist will not view your full record' is probably true, though many may miss the key word "full". Anyone involved in the delivery of care may need to see some elements of your record - few will need or want to see it all. I wonder if Dr Cundy's practice receptionists are banned from seeing any clinical detail? We can spend too much time fretting that the ‘glass is not quite full’ in the new NCRS world, forgetting just how empty it really is at present. Those who prefer the current modus operandi should perhaps read some of the Institute of Medicine or National Audit Office reports to see how poorly we use medical records to save lives or prevent harm. The sooner the professionals start taking a lead in promoting quality and safety in care rather than sniping from the sides, the better. (Post edited by EHI)

slighht variation?

stressfreedave@hotmail.com

04 Mar 08 17:03

The problem is that CfH promoted the SCR as a way of doing away with paper records and claimed it would add security. Putting aside the SUS being given access to the data, the report highlights that data is not any more secure than it was and in fact it is less secure as in the past these non-qualified staff would not have had access to it in the first place. What is the point of spending billions on a system to do away with paper records when it simply prints the records?

It is not a 'slight' variation on access. It is more than that. Patients were led to believe these people would not have access yet they are now being given access. How many other variations are there going to be? I got an email from Bury PCT who pointed out that they had 11 members of staff with access to SUS data (CfH are looking into this and I can supply EHI a copy of the email). Is that just another 'slight' variation?

The new system might save lives, but then again will withholding the fact you were on Viagra 4 months ago from a receptionist kill you? There are loads of ways the NHS could save lifes, this might save a couple but there are ways to save a lot more for a lot less money

Hard copy does not negate SCR benefit

05 Mar 08 10:03

While it's not the topic of the article, subsequent comments hinting that printing a summary for A&E clinicians represents no advance over paper records suggests a fairly fundamental misunderstanding of the benefits of an electronic SCR. Security is only one part of the story, and was certainly never the single driving force behind electronic patient records. There may be valid concerns over the disposal of printouts where these are used, but secure procedures can be established if they do not exist already; I would expect the Caldicott Guardian to have an interest in ensuring such practices meet confidentiality requirements.

missunderstanding of system

stressfreedave@hotmail.com

07 Mar 08 16:03

I am aware that it does more than print paper records and I am aware that it shared far more widely than is claimed.

I was simply pointing out that despite the goverment and CfH talking this would make data more 'secure' because the paper records are 'insecure', it seems rather stupid that they are printing reords to put on patient beds/in files which they claim are 'insecure'. CfH and the goverment did make a big deal about paper records, now we get printed records and the info is now even less secure than it was and available to far more staff. The chances of the doctor/healthcare assistant needing to know a patient with a broken leg was on Viagra 5 months ago is highly unlikely

Minor Correction

10 Mar 08 15:03

Whilst it is always good to have some unbiased comment on important stories of the moment, perhaps I could correct one or two of the points made above:

'First of all [CFH] allow multiple people to use the same smart card' - NO THEY ARE NOT

'now [CFH] appear to have decided to lower the standards even further by pretty much having a free for all - NO THEY HAVEN'T

'The problem is that CfH promoted the SCR as a way of doing away with paper records' - NO THEY DIDN'T - a small contribution to that process maybe

This kind of over-the-top language detracts from the debate and makes those of us with serious points to make about security look like luddite extremists. It really is time to get a grip

Life savings

10 Mar 08 16:03

According to Stressfreedave: 'There are loads of ways the NHS could save lifes(sic), this might save a couple but there are ways to save a lot more for a lot less money.'

The history of public health is littered with examples of managerial or infrastructural changes that have had a far greater impact on health than individual therapies and treatments. NPfIT has more than once been compared to Bazalgette's London sewers, and it's not just the scale and cost parallels that are relevant.

It would be nice to think that one day the neo-luddism frequently expressed in these comments is consigned to the dustbin of history - along with the views of those who though London sewers were a waste of money.

what's the big deal over SCRs?

email@stevebagge.com

13 Mar 08 22:03

Honestly! is people's preciousness over their health records really going to get in the way of medical progress? Is it that big a deal that we're going to let it delay or worse still, completely halt the sharing of data..... the same sharing of data that will make it easier for healthcare experts to gather data, analyse trends and find cures / treatments more quickly. The sharing of data that will allow people to get consistent levels of safe care wherever they are in the country... the sharing of data that, ironically, will actually allow people better understanding of and access to their own data via whatever channel they find most convenient e.g. web, mobile phone, TV etc. In my view, these benefits far, far outweigh the petty issue of a receptionist / assistant noticing that I have testicular cancer or diabetes. Big deal!