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SCR suffers from variable GP data

Tags: DH   GP   Greenhalgh   SCR  

19 Mar 2010

The summary care record roll out

A confidential draft report from the evaluation of the Summary Care Record says data uploaded from GP practices is sometimes wrong but that the SCR can be useful when the data is accurate, Computer Weekly magazine has reported.

The IT magazine says the evaluation team from University College London found examples of uploads from GP records where there were inaccuracies and omissions in the data on medications, allergies and adverse reactions.

The researchers found no evidence that patients had come to harm because of the inaccurate or incomplete data but said doctors took extra time to double check details of medications and allergies, according to the magazine.

Concerns about the quality of the data uploaded from GP practices has been a theme since the SCR was first devised with GP practices originally incentivised to provide good quality data through an IM&T directed enhanced service which sought to create data ‘fit for sharing’.

Since the DES ended in March last year the quality of the SCR has been reliant on primary care trusts implementing data quality standards which has been criticised by some as providing no “carrot or stick” to practices on data quality.

The draft report from UCL is also reported to say that SCRs can be useful for clinicians if they are accurate, particularly if patients are poor at communicating or if they are on multiple medications and have difficulty remembering them.

Other findings reported are that there was no evidence that the SCR made consultations shorter and that in some cases it made consultations longer. There was also no direct evidence that SCRs led to safer carer although it might reduce some rare medication errors.

The final report on the SCR, originally due to be delivered in May but now reported to be published in April, is likely to arrive at a highly politically charged time with an election due in less than three months.

Last week the BMA also called for the SCR roll-out across five strategic health authorities to be suspended because it claimed roll-out had been accelerated before sufficient independent evaluation of the pilot areas had taken place.

Last September Prof Trish Greenhalgh, who leads the independent evaluation team, told EHI Primary Care  that data from the evaluation showed that the SCR sometimes adds value in out-of-hours consultations but so far had made a limited contribution in secondary care.

She said the final report would be a nuanced report on a complex area. “The final report will not say either the SCR is of no use or it’s the best thing since sliced bread,” she added at the time.

The DH told the Times newspaper that it did not want to comment ahead of the SCR’s report publication but said that errors resulted from problems with GPs’ original records rather than the system itself.

Fiona Barr

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Reader's Comments
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Reader's Comments

1

Data Fit for Sharing

ewan@woodcote-consulting.com

20 Mar 10 17:03

The quality of data in GP systems has improved immeasurably over recent years, but in some cases still leaves much to be desired.

However, I'm not sure that exposing poor quality data via the SCR is necessarily a bad thing. It would be too simple to say that data not fit for sharing is not fit for use, but to a significant degree this is my view.

I have concerns that the SCR is a solution looking for a problem, but if it helps highlight poor data quality it should be applauded not berated for this.

Maintaining record quality requires considerable and ongoing effort which needs continuing invest and support. Maybe, the current controversy will help us obtain this.


2

....it all becomes clear....

22 Mar 10 10:03

....at least now we have an explanation for the BMA's reluctance to engage with SCR - they are worried about the spotlight falling on their members standard of record keeping


3

Note to the Doctor bashers

22 Mar 10 11:03

Anyone with a smidgeon of insight into clinical processes recognises that a universally useful summary cannot be automatically abstracted from electronic medical records - akin to (say) a credit rating from your financial records. It's far harder than that and credit ratings aren't renowned for their reliability!

"purpose of GP summary.. for use by other clinicians in unscheduled care settings... an extract of events in the patient’s medical record that may have a bearing on the current consultation."

http://www.connectingforhealth.nhs.uk/systemsandservices/scr/documents/rcgpscrl.pdf

So a summary care record is a referral letter written in advance to someone I don't know, for a contigency I don't know.

The doctor would have to construct and maintain these manually (if constructing them reliably is possible or useful at all).

Can anyone argue that is a good priority for NHS resources?

Meanwhile can EHI commenters (or the editors) keep professional jealousy and sniping off this site!


4

with all due respect...

22 Mar 10 13:03

You don't write a referral letter for unscheduled care, by definition - its unscheduled.

Secondly, a useful summary clearly can be abstracted, as the Greenhalgh report demonstrates, always assuming that the information is there to be abstracted, of course. It is not universally useful, but then no-one said it was

I am not sure that censorship, whether by one professional group of another, or by editors however esteemed, is helpful in moving the debate froward


5

And post your details

paul.stoker@nhs.net

22 Mar 10 15:03

.........stand up and be counted!!


6

Will uploading incorrect SCR information lead to litigation?

22 Mar 10 21:03

The GP should make sure the information is correct and double checked by the patient before SCR upload. Surely uploading incorrect information - allergies / current medication / active problem list / sealed envelope information etc - could lead to LITIGATION against the individual GP.


7

Wrong data or no data?

roger.hook@nuneatonandbedworth.gov.uk

24 Mar 10 09:03

I was always taught that having wrong data (believing it to be right) was worse than having no data. What happens if (when) there are some terrible consequences from using SCR data which turned out to be wrong? Who gets sued?


8

wrong data

24 Mar 10 10:03

What? So we shouldn't have the SCR because some GP's data is wrong and they're afraid they might get sued? What about my rights as a patient? My right to have correct data shared in the event of me being unable to commmunicate my wishes or remember my drug list?


9

Your rights

Neil.Bhatia@nhs.net

24 Mar 10 15:03

for #8:

1) See your GP 2) Check that the data he/she holds in your record is complete and accurate, particularly your "summary" data 3) Give your explicit consent for your GP to upload your information to the SCR - ensure your GP records this (however) in your records

and all your wishes will come true


10

New READ code needed?

25 Mar 10 11:03

I suggest a new READ code is needed for primary care IT systems - "Discussed SCR with patient. Checked Allergies, Active problems, Medications, Sealed Envelope information and Care plan with patient. Patient agreed with data in the EMR and signed form to confirm this. Form scanned into EMR for future reference if necessary."


11

Read Codes

Neil.Bhatia@nhs.net

25 Mar 10 11:03

Already exist.

Simple to incorporate into an "Opt in" template.

Medication review with patient : 8B3x Patient review of medical records : 9N5A Electronic record notes summary verified : 93440 Consent given for upload to national shared electronic record: 93C2

Neil www.nhsdatabase.info


12

Make SCR opt-in template compulsory?

25 Mar 10 12:03

From a medico-legal viewpoint I would advise ALL GP's to use this READ code opt-in template before uploading ANY patient data to the SCR.


13

2 more

Neil.Bhatia@nhs.net

25 Mar 10 13:03

Clinical record verified by patient 9l0 Electronic clinical summary verified by patient 9l1


14

Who gets sued?

cunpr@globalnet.co.uk

26 Mar 10 13:03

Well not the GP. All data is held under the control of a responsible data controller. That data controller is responsible for ensuring that the data he/she holds is accurate and fit for the intended purpose. The IC makes it very clear that the data controller is not absolved of this responsibility by relying on the fact that "another data controller gave it to me". This absolution is further diminished by the nature of the use of the data, the more critical the use the greater the responsibility of the hosting data controller. We are told that the SCR is for use in emergency and "save your life" (so the letters say) situations so it follows that the data controller for the SCR would need to be very sure that the data on the SCR was very accurate and neither therefore would they be able to blame the GP if it were not; the “use” of the SCR is so critical the data controller himself must make every effort to ensure its accuracy.

This is all made very clear in the DPA, fourth principle, on the ICs web site and in his guidance.

So who's the data controller for the SCR?

Its not the GP.

Its the Secretary of State for Health - see Hansard 2008.

The GPs responsibility to maintain his data accurately is limited to the use he/she makes of it.

The Secretary of States position is made even more perilous because when he first directed that GPs would upload to the SCR he used to pay the GPs to check the data before they uploaded to the SCR - an implicit acknowledgement that this was not part of their normal job. The IC would categorise the Secretary of State’s doing this as being a "reasonable effort" under his responsibility to ensure the SCR was accurate.

As the Secretary of State unilaterally decided to stop paying GPs to do this for the wider rollout he has placed himself in jeopardy because in doing so he has withdrawn the only reasonable effort he was making to ensure the accuracy of the SCR.

Who gets sued? - The Secretary of State. He's the data controller for the SCR and he's not making any efforts to ensure the data is accurate.

Paul C


15

Well insured against litigation...

27 Mar 10 10:03

Then let us all hope that the Secretary of State - whoever that might be - is well insured against personal litigation for incorrect SCR information.

Methinks it is time for the GMC to get involved in all this mess.


16

I'ld like to knock some heads together

rsarson@blueyonder.co.uk

30 Mar 10 13:03

As a patient, I cannot understand why all the rest of you are debating these elementary, basic, fundamental points about Records about five years after - as I understand it - the Royal Colleges agreed what data should be in the SCR.

What have the doctors' negotiators and CfH been doing this last five years to resolve their differences, and create a secure and patient-friendly health record system.

The answer is: nothing. All both sides have done for five years is score debating points against each other, and throw the occasional brick-bats.

Meanwhile, the patient waits, and waits, and waits. Have you all forgotten what you are there for? Improving patient-care. Someone should come and knock your - IT people, administrators and clinicians alike - heads together very soon and very hard.


17

medico legal questions and answers

31 Mar 10 07:03

Unlike the previous commenter who believes we have done nothing but score points- a great deal of work has been done by the SCR team to answer these questions and many others that have of course repeatedly been asked. The 35 complex medico legal FAQ are published on the website below for 1 year now.As the comment above asks these answerds are authored by the MPS and GMC. http://www.connectingforhealth.nhs.uk/systemsandservices/scr/documents/mpsfaq The question of liability is answered below 2. Who is liable if the information in the Summary Care Record (SCR) is factually incorrect? What is my liability if I act on information? Just as with manual records, healthcare staff are generally entitled to rely on the clinical notes. Liability for an erroneous entry would usually lie with the person who made the entry, unless there was an obvious discrepancy which should have been picked up by anyone reading the record. In some circumstances, where the information is of particular importance, and easy to check (for example, a drug allergy), there might be an expectation that the clinician check the position with the patient. Gillian Braunold Clinical Director SCR


18

DO NOT UPLOAD UNVERIFIED RECORDS!

05 Apr 10 12:04

The response from Gillian Braunold to all clinicians is very clear. DO NOT UPLOAD SCR DATA UNTIL YOU HAVE CAREFULLY VERIFIED ALL THE INFORMATION WITH THE PATIENT.

Failure to do this and then uploading incorrect / misleading / out of date data is the responsibility of the GP / Clinician and any legal complaints / compensation will be directed against that person.

I agree with the BMA, this program needs immediate SUSPENSION to give GP's sufficient time to verify their clinical records with individual patients.

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