PCT seeks to align SCR and SystmOne consent models

Tags: CfH consent PCT SCR SystmOne

09 Sep 2008

The last of the six primary care trusts due to take part in the early adopter programme for the NHS Summary Care Record has insisted that the data sharing model for the SCR and its main GP system supplier should be the same.

South West Essex PCT is the last of the PCTs named as early adopters for the SCR, but was not included in the evaluation of first sites to use it earlier this year. More than 80% of its GP practices use TPP’s SystmOne, which is introducing a new data sharing model as part of its latest release, R3.

In July, EHI Primary Care reported that GPs had expressed concern about the Enhanced Data Sharing Model introduced in R3 and CfH said the system was under review before further roll-out.

The model means all patients must choose whether their information is “shareable” with all other SystmOne units with which they are registered or “private”. Patients may also opt to treat some individual events as “private” while leaving the rest of their record shareable. The default option for patients will be “private”.

This week, a spokesperson for South West Essex PCT told EHI Primary Care that the PCT wants R3 to offer patients the opportunity to give or withhold consent at each health encounter. This would mirror the new “permission to access” system for the SCR, which is expected to be ratified by the Care Records Service Programme Board next week.

The spokesperson added: “The decision has been taken here that patients should be offered the same consent model regardless of which system they are using so that permission to view would be used for SCRs and for data sharing via SystmOne.”

He said that in the first instance this would involve a change to business practices with clinicians required to ask for consent each time they viewed data shared via SystmOne.

If the “permission to access” is given approval next week, coding changes will need to be made to all GP systems to reflect the changes in the consent model.

The spokesperson added: “We are talking about defining the best system here rather than just doing what is the most convenient for the NHS.”

Four practices in South West Essex have currently signed up to take part in the first wave of the SCR programme. The launch of the SCR in the trust will probably happen in October, the spokesperson said.

Fiona Barr

Reader's Comments

SCR and the detailed Care Record

09 Sep 08 16:09

There is a huge difference between a patient giving their consent for a clinician to view a Summary Care record which only has basic information i.e. Medication, main diagnosis. The 'Consent to View' model works well in the the case of SCR or Out of Hours. However you cannot apply the same model to a Detailed record that holds years of the patients information. If a detailed record works in a 'Consent to View' Model it would not give the patient the opportunity to have reviewed their full GP record prior to giving their consent therefore you could end up with a situation whereby a patient consents for a Community Nurse to view their GP record and then is shocked to see that the Community Nurse saw information on their Termination of Pregnancy. I thought this debate had already taken place and 'Consent to View' for the detailed record thrown out. It is about time someone understood the fundamental difference between an SCR and a Detailed record and properly understood the actual practicalities of how this would work at practices and Community services.

Not ideal for the detailed care record

trudi.mount@nhs.net

10 Sep 08 09:09

I totally agree with the above comment. Consent to View for the detailed care record is not a workable solution. Most record access, especially within Community, is done without the patient present and in many cases several days later! How does this deal with being able to view your bit of the record but not other services if the pateint says no to viewing but has said yes to sharing. The whole thing is a minefield.

Another approach to record access

brian.fisher403@ntlworld.com

10 Sep 08 11:09

There is another way. EMIS, with PAERS Ltd, has made it possible for all EMIS practices to enable their patients to access their full GP electronic record online or in kiosks in the waiting room. Only the patient has the key to this data. If the patient chooses to share their pins and passwords or to show their information to some someone they can.

We now have experience that this is robust, straightforward and effective. We hope to publish soon.

We now need practices to see that this is a safe way of involving patients in their care. There are safeguards if practices or patients are concerned about inappropriate data being seen.

Brian Fisher, co-director of PAERS and lead for the Record Access Collaborative, a post funded by EMIS

EMIS Access

Neil.Bhatia@nhs.net

10 Sep 08 16:09

Am starting to trial this. Now working very well. And it ticks all the right boxes.

• Patients have to want it and ask for it. In other words, it's an opt in, only with the patient's explicit consent. (Compared with....) • No data is uploaded to any database, government-controlled or otherwise. • It does not allow any extra people to view the medical information other than the people who would normally have access to it at the surgery, unless... • You can, if wished, give your logon credentials to someone to allow them temporary access to your records – for example, to a doctor elsewhere in the UK or abroad - and then contact your surgery to disable access via that logon. You have to be mindful that personal information (e.g. home address) can be seen on scanned letters.

A simple factsheet that I created for patients is here: http://tinyurl.com/5ftz3r

Haughton Thornley Medical Centres have the most experience, I think http://tinyurl.com/6zjkcm

Fit for purpose?

maryhawking@tigers.demon.co.uk

14 Sep 08 11:09

I sympathise with Essex wanting to have the same or similar consent procedures for summary and detailed care records - especially as the consent model within TPP is changing at the same time: I suspect patients *will* get confused by all the different shared records they suddenly find they have! (*Did* they know that they had acquired a shared record when their practice changed to SystmOne?). I am not sure that the operational requirements of one PCT pilot should dictate the consent (or lack of consent) for the detailed care record - the true SSEPR. What happens when it is clear that refusal to allowing viewing of the full detailed care record may provide a legal defence in case of complaints? "Yes, the information *was* available - ***but the patient refused to allow me to see it***!"

Consent to view in the TPP Detailed Care Record

24 Sep 08 16:09

The nature and purpose of the summary care record and the TPP systmone detailed care record is different !. The SCR is a summary largely singluar record primarily (but not exclusively) intended for use in unscheduled care situations. Here a consent to view model is entirely appropriate as it is difficult for a patient to give prospective consent out of context. Indeed this is the successful model used in the systmone OOH/A&E modules. The systmone detailed care record is a multi organisational multi unit record allowing patients much more control over accessibility to the components of their record. The consent to share is the appropriate model for this. Patients will not always be present when the detailed care record is accessed (eg child health). The consent to view model must implicitly mean records are not shareable by default and only "shareable" when the patient is present ot give consent to view.

In N Lincs PCT where we completed the TPP Systmone DSM pioneer rollout we have not identified a requirmement to adopt a consent to view model for the detailed record as it would clearly be unworkable in most situations. However there are some circumstances where consent to view/on access is appropriate such as OOH and this would work in the same way as the consent override functionality. We have submitted development requests for this. Doug Scott, N Lincs PCT

Step in the right direction?

stressfreedave@hotmail.com

28 Sep 08 09:09

Whilst I think there are flaws in this idea/system, I think it at least shows PCTs are starting to think about the way patients decid about data sharing. There are some obvious questions that need answeres, such as how can a patient make info sharable with others whilst at the same time restrict access to some others? Is there an overide button to allow access without consent? Is data shared on a 'team' basis or on a role basis?

I think the comment about the community nurse a bit suprising because according to my last 2 PCTs (what was Morecambe Bay PCT and Grampian) such information would be available to the nurse and even some admin staff. When I tried restricting access to a nurse and some admin staff both PCTs made it clear patients restricting access was not an option.