NHS must learn lessons on centralised patient records

Programme so far has not focused enough on social aspects of the technology change

Tom Young, Computing 06 May 2008

The NHS summary care record (SCR) programme is offering real benefits to early adopter sites across England, but the technology needs to be simplified before further rollout, according to a major independent study by University College London (UCL).

The SCR initiative – a key part of the £12.4bn National Programme for IT (NPfIT) – aims to provide a centrally-stored electronic health summary from a person’s medical records that can be accessed by a variety of health professionals in different locations.

The survey, which looked at four out of the six early adopter sites for the new system, found that the programme was delivering less paperwork, improved efficiency of patient processing and better patient safety. Further benefits are expected from accident and emergency staff access to medical records, but this aspect of the plan is harder to judge during such a limited phase of adoption.

But the study also found that the project had suffered due to over-focusing on the technical aspects of the implementation.

"The SCR team within Connecting for Health (CfH) has been criticised (in our view, justifiably) for taking a narrow and instrumental focus on implementing a technology rather than a broader and more developmental focus on socio-technical change," says the report.

"A shift to a more socio-technical perspective would change the SCR programme considerably, for example, the SCR would no longer be seen as an end in itself, but as a means to other ends."

Such a move would also help engender positive staff and patient perceptions of the system.

A number of technical glitches and operational problems with the SCR and the clinical spine application on which it is held led to long delays and considerable frustration on the part of some staff.

The report notes that political and media attention on the project forced CfH – the NHS agency responsible for NPfIT, which commissioned the study – to enforce "a tightly-managed, largely non-negotiable timetable" which some clinicians felt they had not been adequately consulted on, leading to a degree of resentment.

The report also found that a high proportion of patients in early adopter sites did not recall receiving information about the SCR – despite widespread information campaigns.

This concerned the UCL team because it meant that many patients whose records were being transferred to the SCR would not be aware of the privacy implications, specifically that professionals other than their personal GP would have access to parts of their medical records.

But the report found that many patients were less concerned about this than some privacy campaigners had suggested.

"Many people readily admitted to being 'not bothered' whether they had an SCR or not, but if anything they welcomed it because it meant that there was less need for them to remember what was wrong with them or what medication they were on," says the report.

At the end of April 2008, the SCR of 153,188 patients in the first two sites had been created.

A total of 614,052 patients in four early adopter sites had been sent a letter informing them of the programme and their choices for opting out of having an SCR, or limiting access to it.

Of these, 4961 (0.81%) have actively opted out of having an SCR and 154 (0.03%) have asked for data on their SCR not to be shared.

Delays in two sites where most GP practices were served by different software suppliers were largely due to the failure of some software contractors to deliver key technologies to agreed schedules.

CfH said the report provides a number of important learning points, particularly on the question of patient consent to use the SCR. It will discuss these issues with stakeholders.

Meanwhile, the early adopter programme will continue in its present form while the SCR Advisory Group considers the report’s findings before further rollout commences.

"We set up the early adopter programme to ensure that problems, issues and practicalities of implementation were tested out in real-life healthcare situations in a controlled and safe environment," said Gillian Braunold, clinical director of the Summary Care Record and HealthSpace Programme.

"The report offers the programme the foundations on which to base the necessary planning for improvement in design and implementation before national rollout," she said.

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