Dr Nigel Watson says that before accessing a patientês electronic health record, verbal consent should be obtained whenever possible (•Your problems solved: ITê, September 2002).
At present, with written records in hospital or general practice, or computerised records in a practice or co-operative, no consent is obtained. The only exception to this is in the case of genitourinary and infertility clinics.
If a health worker is treating a patient, there should be no need to obtain consent as long as the information in the record is kept confidential and is used for treating the patient.
Dr Andrew Thornton, GP Calne, Wilts
Dr Nigel Watson replies:
The original question related to health records held by the GP which had been placed in a format to which other healthcare personnel outside the practice could have access, for example in an accident and emergency department or the GP co-operative. Therefore, it would be best practice to obtain verbal consent from the patient before staff in these organisations had access to the patientês emergency electronic health record.
The examples Dr Thornton uses are of organisations looking at their own records, and consent for access to these records is not generally required. The exception to this is when the purpose for which access is required falls outside the Data Protection registration. For example, records being examined for research purposes when this use is not stated in the Data Protection register entry.
Sharing information without explicit consent of patients is an issue at the centre of the IM&T revolution in the NHS. Many different views are expressed, ranging from the desire for a complete ban on access unless the patient has signed a valid, informed consent, to the liberal view that the information should be readily available for access by all.
We must remember that this information is to be used to assist in the healthcare of an individual patient, and we must be careful not to be so rigid with interpretations of legislation that we block the legitimate use of the information for the patientês benefit. The advice given is aimed at minimising risk - it is impossible to avoid risk completely.
Having read the news item on measuring ear temperature in children (•Ear thermometry is not reliableê, September 2002), I canêt help wondering whether we are wasting time in investigating the subject.
In 25 yearsê experience in general practice, I have found monitoring temperature the least useful investigation.
Checking the temperature is not helpful in a community setting. It is more important to treat an infection than to subject distressed children to frequent temperature taking.
Dr Kadiyali Srivatsa, GP