The NHS Executive has announced that from 1 October 2000,1 GPs in England are able to maintain part or all of their patient medical records on a computer system.
This has resulted in a change in GPs' Terms of Service and amendments to the regulations for GPs working in personal medical services.
Health authorities have been instructed to approve all requests for GPs to maintain electronic patient records (EPRs) if the following conditions are met:
- The computer system on which the EPRs are maintained must be accredited to Registration for Accreditation (RFA 99)2 standards.
- The doctor is aware of, and has signed an undertaking that he/she will have regard to, the guidelines contained in Good Practice Guidelines for General Practice Electronic Patient Rectords.3
The guidelines were produced by the Joint Computing Group of the General Practitioners Committee of the BMA and the RCGP.
The guidelines cover:
- Hardware requirements
- Electronic record requirements
- Maintaining security
- Medical confidentiality
- Training and other resource requirements
- Regulatory requirement.
Practices will need to ensure that the central processing unit has sufficient capacity for both the short and medium term. It should be protected by an uninterruptible power source and regular back-ups of all data. If the back-ups are stored on site, they should be kept in a fireproof safe.
There should be a supported local area network, with workstations positioned at points where staff will need to have access to the EPR. Printers are required for printing both FP10s and letters, reports and part of the patient's EPR.
Due regard must be taken of the Health and Safety at Work Act 1992. Thus VDUs must comply with the law and furniture must be suitable for computer equipment.
A common set of codes (Read codes) are currently used in general practice. This is essential to shared understanding between computers and will become even more important when records are transferred electronically between practices.
The use of 'free text' needs to be understood. If diagnoses or measurements are not coded, they cannot be searched for. This has enormous implications for EPRs transferred between practices. For example, if the code for epilepsy 'F25' was added and qualified by the free text 'excluded by EEG', it is not difficult to see how this could cause problems.
The practice needs to consider how it will deal with data from sources outside the practice, e.g. out of hours, secondary care and previous practice. The development of electronic transfer of these data will obviate the need for this.
The practice security policy should identify the need for data entry to be restricted to properly trained and authorised people.
It is essential that all users:
- Have a unique user identity and password
- Keep their password secret
- Change their password regularly
- Log out of workstations when their tasks on that workstation have been completed, and never leave a work station logged in but unattended.
The computer system must have a virus checker that is always used to screen any files added to the system.
Transfer of electronic records between practices should commence in 2004.
What should you do if you wish to move to EPRs?
- Read the Good Practice Guidelines for General Practice EPR
- Discuss the move with your local medical committee
- Draw up a plan to submit to your PCG/T for the additional resources you will need in order to carry this out, including hardware, software, additional staff time and training.
Plan your transfer to EPRs in a staged manner, e.g. a migration pathway could include the following:
- Use of registration links
- Use of Items of Service links
- Use of pathology links
- All electronic repeat prescribing
- All electronic acute prescribing
- Appointments system
- Cytology results
- Vaccination records
- All measurements, e.g. blood pressure, height and weight
- All investigations
- Summaries of previous paper records
- Disease-specific or chronic disease management data
- Part of the consultation
- All the consultation
- External consultations
- External text-based communications
- Use of associated electronic information sources and decision support software
Finally, it has been estimated that up to 30% of practices are not registered under the Data Protection Act 1998. It is essential that all practices are registered, as the new Act covers both written and computer records.
- Although based on a joint GPC and RCGP document, this article reflects the author's personal view and not necessarily the views of the BMA or RCGP.
- NHS Executive letter 01/10/00. Electronic Patient Medical Records in Primary Care.
- General Medical Practice Computer Systems Requirement for Accreditation RFA 99. NHS Information Authority: October, 1999.