Summary care records planned for end of 2008

Tags: CfH Community consent GP GPs HealthSpace Helpline NHS Direct NHS Number PCT Public information programme SCR Summary Care Record

27 Feb 2007

Connecting for Health is planning for every patient in England to have a complete Summary Care Record by the end of 2008.

Guidance prepared by CfH for strategic health authorities makes it clear that the Clinical Summary Record will be implemented in two phases. Phase one, due to begin by Easter, will consist of an early adopter implementation of the GP part of the summary care record (SCR). Phase two, to be complete by the end of 2008, will use the findings of the early adopter phase for a full roll-out across England of the SCR by the end of 2008.

The guidance sets out in detail how the implied consent model for the early adopter sites will work and patients’ options for withholding consent. If patients do not opt-out an initial text based summary of their medications, allergies and adverse reactions will be uploaded to the spine. If patients choose to dissent from data sharing, a patient’s summary record will be restricted to the authoring GP only.

After the upload patients have two options. They can choose to remove some items from their summary record, known as ‘tailoring’ and done by the clinician, or they can send a blank summary update which includes demographic information only and a message that the patient has chosen not to have a summary record.

Patients can consent to sharing their summary, dissent from sharing but still have the information uploaded in case they change their minds or dissent from sharing and have no summary uploaded.

The initial summary will be replaced with an update summary, which will be triggered by a consultation and contain coded and possibly more comprehensive information. This will allow the GP and patient to validate the summary and choose from further options for updating the summary. After that a summary record will be triggered by a significant event such as a test result entered from a discharge letter.

The guidance adds: “The early adopter programme will evaluate the process by which patients and GPs can identify and agree which elements of the clinical record should be uploaded to the spine.”

The guidance says patients will be fully informed about the SCR through a public information programme and that NHS Direct will provide a helpline which will be the first point of contact for patients to ask more questions about the SCR.

The guidance says that, in order for the summary record to be of use to clinicians in unscheduled care, deployment of the Clinical Spine Application will be held back until a critical mass of 60% of patients in the health community has a summary record.

The guidance sets out a range of activities primary care trusts and GP practices will need to complete to implement the SCR including undergoing data accreditation, upgrading GP systems to be SCR compliant, training in the new functionality and engaging with patients.

The document states that the first wave of the early adopter programme will begin in the first quarter of 2007/8 with a small number of practices in one PCT, followed by roll out to more practices in that PCT and the trial of the programme in a second PCT. In the last two quarters of the year second wave practices will go live with the SCR. Access to the SCR via Healthspace will be available from May or June 2007.

The guidance adds that the rollout of the SCR is dependent on the release of 2006-B Spine release, due 26 March, and GP compliant systems. The early adopter sites are to be limited to 2.5m patients.

The second half of the 26 page guidance document focuses on work hospital trusts will need to do to prepare for the SCR including upgrading all their Phase 1 Release 1 (P1R1) systems by the end of December 2008. Trusts that use an existing system will also be required to upgrade to the full NHS Care Records Service including cleansing their Master Patient Index to meet the mandatory use of the NHS number and issue smartcards to all staff.

The guidance also covers plans for the NHAIS (Exeter) system to use the spine as its source of demographic data.

Link

Implementing the Summary Care Record

Reader's Comments

Original link

Neil.Bhatia@nhs.net

27 Feb 07 14:02

http://nww.npfit.nhs.uk/implementation/documents/Implementing_Summary_Record.doc

(NHSNet connection required)

Newsflash

27 Feb 07 21:02

The moon is made of Camembert. :-)

CTV3 - did they say something was going to be exchanged between computers in the NHS?

david.churchill@nhs.net

01 Mar 07 11:03

We use CTV3 - shall I just give up hope now! Today is St David's Day - I thought for a moment it was 1st April !!!

Patients concerned

01 Mar 07 20:03

The pilots sites have already been chosen it seems, and their patients are concerned...

http://www.hertsad.co.uk/content/herts/news/story.aspx?brand=HADOnline&category=News&tBrand=herts24&tCategory=newshadnew&itemid=WEED15%20Feb%202007%2011%3A47%3A32%3A230

http://www.thisishertfordshire.co.uk/news/newsindex/display.var.1218624.0.controversy_over_surgery_database.php

Coding and summaries

angus.goudie@GP-A89021.nhs.uk

02 Mar 07 09:03

Much of the problems will be helped by migration to SNOMEDCT which is still moving ahead very actively. I'm sure someone questioned this yesterday in commnets but I don't see that today. Mapping tables from Read2, developement for many susyems primnary and secondary care, and early use in newly rolled out systems in secondary care ans some pilots in ambulance and secondary care and community are a start, but all GP systems will be mapping to SNOMEDCT in the background at least to be able to be in the pilots for the summary.

Re: Coding and summaries

colin@clinformation.com

02 Mar 07 11:03

I don't share Angus Goudie's confidence that the adoption of SNOMED CT (or any other terminology) will - of itself - be as helpful as his comment appears to suggest. It would help to understand what he means by "migration": is this replacing Read-enabled GP systems with SNOMED systems? or translating existing Read coded databases into SNOMED databases? Also by "mapping": is this identifying codes in SNOMED that appear to identify the same concept as a particular Read code? or offering a solution to the difficult problem of ensuring that the precise meaning of a SNOMED-encoded record derived from one that is Read coded is preserved intact?

Angus may be privy to some unpublished material from pilot sites, but there is little evidence in the wider domain to suggest that introduction of a universal coding scheme (even of the comprehensiveness and technical quality of SNOMED CT or CTV3) will safely allow widespread multi-professional input to (and reading from) a record such as SCR.

It's an important hypothesis that urgently needs to be tested.

Re: Coding and summaries

angus.goudie@GP-A89021.nhs.uk

02 Mar 07 13:03

I understand some of Colins concerns. With regard to mapping I am confident that this issue is being dealt with satisfactorily. I also can't see any great cause for concern with a one way transfer of data from Read2 to SNOMEDCT and then stored and visible on the Spine summary which is what is envisaged in the near future. I know that the GP suppliers are working towards SNOMED systems as opposed to mere mapping but that may be some way away and it is obvoisuly important that this should be at some stage a true SNOMED front end rather than merely mapping from a pseudo Read2. that however may be safer in the very short term. Where i am yet to be persuaded is that data can be eneterd from primary and secondary care into a single database of SNOMED termed data. the difference in provenance of that data will colour how it is recorded as the reasons for recording vary with context, and hospital are much more concerned with episodes of xare rather than the more prolonged epsideos of illness. Interoperability with the data from each source clearly delineated, but the option for accepting individaul data itmes into your system (e.g. copy across the surgical procedure from hospital sytem to your practice rather than re-key) would seem to me a safer option than a mega database with many owners. I hope that statements at the Birmingham NEC conference 'Quality Data:Quality Care' on Tuesday may clarify some of the issues on the way forward.

Patient Concerns

04 Mar 07 21:03

The practice mentioned in the 'patient Concerns' comment is not one of the early adopter sites, the press are barking up the wrong tree. What is even more suprising is that another local paper referred to the DoH confirming the story, without even checking that the practice was in an early adopter area!