Dr Nigel Watson answers questions on universal healthcare records, purchasing of practice IT systems, and NHSnet
Q I have read recently that the NHS will be developing a universal computerised healthcare record for each patient; does this mean the end of the practice-based clinical record?
A Currently in the NHS, separate computerised medical records are held by GPs, community pharmacies, pathology laboratories and hospital outpatients, A&E and X-ray departments, to name but a few. Often each of these departments is having to enter data that are already held on another clinical system. This does not help patient care and is not an efficient use of resources.
The NHS is slowly modernising its IT systems. Projects that have been completed or are being evaluated include:
- Electronic prescribing – the electronic transfer of prescriptions from GP surgery to pharmacy and on to the Prescription Pricing Authority
- Electronic delivery of pathology results to practices
- Electronic delivery of X-ray results to practices
- Transfer of electronic medical records from one GP practice to another
- Electronic booking of hospital appointments
- Electronic patient referrals
- Emergency electronic patient records
- Encryption of patient identifiable data sent over the internet.
The purpose of all these projects is to connect up what are essentially ‘data islands’ and ensure that information is handled efficiently and in the best interests of the patient.
The Department of Health is now consulting on the Integrated Care Records Service (ICRS). The proposal is that ICRS will be at the heart of a national modernisation programme for IT in the NHS.
Phase 1 of ICRS, running from 2003 to 2006, will focus on viewing systems and data and include enabling clinicians to:
- correspond by email
- browse internet and intranet sites
- view basic clinical information such as laboratory and X-ray results.
The Myhealthspace service, for patients, will be developed to give them access to their health record and allow them to add further data that is not linked to the local system.
Phase 2 (2006-2008) functions will be more interactive and include:
- Access for clinicians to a more comprehensive patient record that includes specialist results, GP prescribing history, hospital discharge summaries and clinical documentation
- Greater ability to make electronic referrals, requests and orders
- Further support for clinical activities and workflow.
Phase 3 (2008 onwards) will aim to integrate care across health and social services and include:
- decision support software
- community-wide prescribing
- clinical documentation that includes assessment and care planning.
This will not mean the end of the practice-based clinical record. Practice systems will remain, but all healthcare professionals will have access to comprehensive clinical information and contribute to it.
One potential model involves downloading records from different places onto a central database. For example, GPs could add records relating to major illnesses, recent prescribing, allergic reactions, and measurements such as blood pressure, and hospital clinicians could add significant details of an outpatient appointment or inpatient stay, including, for example, blood test and X-ray results. The additional information could then be downloaded from the central database into either the GP or hospital records.
All the information contained in the central record would be available to healthcare professionals, subject to any access restrictions.
There are real issues about patient confidentiality that need to be resolved, but ultimately an electronic record such as this will benefit the patient and prevent duplication of computerised clinical information.
Q The practice has been told that from this autumn large consortia will be purchasing IT for the NHS and this will prevent GPs from choosing their own clinical systems. Is this correct?
A An announcement to this effect was made, however, it has since been retracted. The Department of Health has confirmed to the General Practitioners Committee of the BMA that GPs will be free to choose their clinical systems from approved providers without interference.
In May 2003 the DoH announced that five local service providers would be appointed to provide a range of applications, systems and services needed to support the National Programme for IT. They will cover the following areas:
- North-east, Yorkshire and Humberside
- South-east and south-west
- East of England and east Midlands
- West Midlands and north-west.
Areas are based on local government regions to enable the NHS to benefit from joint working with local government. The contracts for London and north-east, Yorkshire and Humberside were due to be awarded in autumn 2003, with systems starting to be put in place in the next financial year. The three remaining contracts were due to be let by the end of December 2003.
Q I am a nurse practitioner with a single-handed GP. He is IT phobic and although we have internet access in the surgery he will not let anyone have the access codes so we can use it. I would like to register for NHSnet – how can I do so without a password?
A I cannot think of any reason why a GP should stop you having access to NHSnet; it is essential for all clinical staff.
An IT phobic GP needs to be reassured and encouraged to move into the modern age of communication. Ask him why he will not let you have access. If he is concerned about the system being abused all he needs to do is to set a standard code of practice for the use of the internet.
Access to the NHSmail site is available without a password only via NHSnet. If you try to access it through the internet you will be asked for a password. The NHS Information Authority helpdesk (tel: 01392 251289 or email: firstname.lastname@example.org) can help if you are having problems in accessing NHSmail through NHSnet.