Summary Care Record use jumps in Bolton

Tags: Adastra GP Quality SCR Solution Summary Care Record

26 May 2009

Use of the Summary Care Record by the out-of-hours service in Bolton has risen from 200 accesses a month to 200 accesses a week following the introduction of an integrated ‘SCR’ system from Adastra.

Adastra’s integrated SCR enables fast ‘two click’ access to the national Summary Care Record than was previously available, enabling summary care record access to become routine to check whether a patient has an SCR record.

The increase in uptake has been mirrored in other urgent care settings in Bolton where the Adastra SCR integrated solution is available, according to Dr Darren Mansfield, NHS Bolton’s clinical lead for urgent care.

He told EHI Primary Care: “The difference since we’ve had the integrated system has been exponential and it’s still rising. The integrated version has had a dramatic effect on the number of hits and the benefits we are starting to see.”

Dr Mansfield said the Adastra solution gave access to the SCR within two clicks and was available in the out-of-hours centre, Bolton’s walk-in centre and the GP service at Royal Bolton Hospital’s A&E department.

“We basically access it as the norm now unless a patient withholds permission and that has never happened to my knowledge," he added.

Dr Mansfield said the difference between use of the SCR in the GP stream in the A&E department at the Royal Bolton Hospital and use by staff working in the main emergency department was marked.

He added: “The GP stream can access the SCR through Adastra where it instantly flashes up to tell you if the patient has an SCR but the emergency clinicians have to go on to the national Spine and look to see if a patient has an SCR and the difference in access is very noticeable.”

Dr Mansfield predicted the usefulness of the SCR would increase as more content was available via the application. The initial automatic upload contains just the patient’s prescribing history and any allergies but Bolton is following its fellow SCR early adopter NHS Bury by piloting the addition of end of life information.

He added: “I believe the addition of that information will mean the impact out-of-hours services can make on end of life quality of life would be phenomenal.”

Fiona Barr

Reader's Comments

Compulsory use

26 May 09 12:05

Within Adastra there is functionality that makes it compulsory for clinicians to access SCR before they can proceed with any consultation recording.

No faster way to bump up the figures.

Compulsory use

simon.wren@adastra.co.uk

26 May 09 17:05

It is not mandatory to view a summary care record within Adastra, although I think I understand how this misconception might arise.

When a clinician first opens a case a dialog box is displayed alerting them to the fact that a summary care record exists for the patient. They do not, however, have to view the SCR in order to record the consultation details and complete the case.

I hope this helps clarify the point in question.

re: compulsory use - why wouldn't you?

glen.griffiths@interactivhealth.co.uk

26 May 09 17:05

Notwithstanding the privacy and consent concerns that are regularly expressed in these pages around the SCR, it does seem to me that putting a fixed step in place for clinicians to request access to a patient record (where it exists) is obvious in an OoH setting.

If a record is available, why would a prescribing physician not want to request patient consent to use it? (I'm assuming that is what happens btw and if a patient declines, the SCR is still regarded as being unaccessed - important given the changes on retrospective deletion reported today)

Given that the vast majority of patients will give consent, it is essential that presenting patients are involved in a dialogue around its use as evidence confirms that many patient records are incomplete or contain inaccuracies. How inaccuracies will be communicated or put straight at source (or at least noted) still remains a thorny issue however. Any solutions out there?

The concerns over utility of access to SCR over the spine in A&E will rumble on until workflows change to support it and numeric comparisons at this stage may be meaningless.

Issues still remain but progress is being made - it would be now good to hear what real patient benefits are being derived from routine access to records in OoH. How will it improve care? Tangible impact on safety etc., Not easy to collect that info but valuable all the same and will help us to move rapidly from conjecture to fact.

No conflicting interests

scr not used every time

27 May 09 07:05

Integration of SCR into the application enables a tab showing the SCR to be easily available. The figures are showing that approximately 25% of OOH consultations where SCR could have been looked at it was accessed in the integrated product.

Obviously some consultations are very simple and SCR does not add value. A questionnaire over Easter weekend in both Bury and Bolton is demonstrating clinicians feeling more confident with access to the information that they have in their consultations and changing their prescribing choices.

Gillian Braunold Clinical Director SCR

All very good but...

27 May 09 10:05

Totally agree with the need to gather impartial feedback on the summary care record and its value. Hopefully more research on this will follow.

Simple question: how does a clinician know whether the data in the record are accurate, up-to-date and a fair representation of the patient's clinical conditions?

Simple answer

27 May 09 12:05

The same questions applies to any information a clinician uses in the course of their work - and the answer is the same. They make a judgement by applying their knowledge and experience to the totality of the information they have available, weighing up the likely reliability of the sources. The SCR is part of the mix - and potentially a very useful one.

Not so simple really...

27 May 09 21:05

Excellent answer... The key is that the clinician has to make a judgement based on what they know - usually from a clinical history and examination. There is no substitute for good clinical practice, although in many cases the care record may provide useful short-cuts.

As regards conventional records, they come with the potential to review the basis of a diagnosis - which after all is an opinion, and possibly wrong. The summary record presents no such opportunity.

Add to that, no clear line of accountability for wrong data and information hiding in 'envelopes' and the landscape changes somewhat.

A good approach for the clinician to these summary records is healthy skepticism. Use them by all means, but as with all things 'IT', don't assume that norms from the pre-existing culture apply.