This video from Liverpool vividly points out how essential it is for clinicians to share patient records with each other. In real time, at the point of care. It can be life-saving. It is shocking how so many procedures, mainly in secondary care, can be relatively free of past patient data.
Healthy Liverpool Presents : We Share Because We Care from LittleJeff Productions on Vimeo.
This is well recognised across the NHS and social care and there are a number of solutions out there. The universal solution is the Summary Care Record on the Spine. This is now available to all hospitals in England. It shows the Problem list, Allergies, Medication for all people in England with an NHS number. This is useful in most situations. However, as I understand it, the system is so clunky that hardly anyone uses it. You could have done the appendicectomy by the time the information appears on the screen.
There are also a number of bespoke solutions across the country. One of the problems is that, even within a hospital, there may be many different IT systems: one for cardiac, one for gastro etc. They have usually been developed by smart doctors and work well for that department but the IT systems often don’t talk to each other and won’t talk to GP systems or ambulance vehicles. And many hospitals still do much of their work on paper. In keeping with this fragmented approach, many individual health economies are developing, with IT companies, interoperable processes so that clinicians and sometimes social services in any area can share data. That is the Liverpool solution. It is good, but will still not solve the problem of sharing data between areas. Lots of people move around a lot. In addition, it can involve complex sharing agreements across different sectors.
Of course, in Scotland, they have had an effective, cheap system for years which has enabled everyone dealing with emergency care to share information. The Emergency Care Summary (ECS) is a shared record system offering controlled access to medication and adverse reactions details for 99.97% of patients in Scotland. It holds a secure central copy of these parts of the GP practice’s record and is updated automatically twice daily. 81% of clinicians said that ECS was helpful or very helpful and felt that it changed their clinical management in 20% of cases.
Until we have replumbed the IT system for the whole of the NHS to ensure interoperability (which actually may be possible in the next few years and has been done in Estonia ages ago) there is an excellent solution which will work now and which solves most of the problems, for free and integral to the NHS itself – give the people their GP record and support us to share with clinicians across the NHS. Anyone who wants it in England can have access to their Summary Care Data plus their primary care test results from April 2016. This is funded by the NHS and links in real time to the patient’s GP record. This approach involves the patient, improves trust, encourages self-care, helps people understand what is happening to them in the care system – and shares data with no ethical or confidentiality issues. Work is planned on an ICE-type approach whereby clinicians could break into the system on behalf of an unconscious patient.
This is not currently available in UK countries outside England, but it probably will be soon.
So, patient power is yet again a solution to complex and expensive problems in healthcare. Let’s remember and apply elsewhere.
Dr Brian Fisher, is a GP and director of PAERS Ltd , a company on the government Framework to deliver record access and other patient-facing services to the NHS.