Five areas in England have been announced as the pilot sites in a project that will see community pharmacists access certain patients’ medical records, marking a move towards crucial data sharing between healthcare professionals.
A total of 100 pharmacies across Somerset, Northampton, North Derbyshire, Sheffield and West Yorkshire will be able to view a patient’s summary care record (SCR), which contains information such as a patient’s current medications and allergies.
The “proof-of-concept” project was announced in June 2014 and is being run by NHS England and implemented by the Health and Social Care Information Centre (HSCIC).
“Community pharmacists have been campaigning for access to patients’ medical for years in order to enable provision of the safest care possible,” says Dave Branford, chairman of the Royal Pharmaceutical Society’s English Pharmacy Board.
It is expected that the first pharmacies will go live at the end of September 2014. The 100 pharmacies should have access to the SCR by January 2015 at the latest.
“The pilot runs until March 2015 and it is at this point that we will be evaluating the success of the project,” Mohammed Hussain, systems commissioning manager in strategic services and technology at NHS England, said at a meeting hosted by the RPS and the Central London Local Practice Forum on 3 September 2014 in London.
Patient-centred care is the ultimate goal and the technology is just a means to an end, stressed Hussain. “Our research shows that the biggest advantage of the SCR is improved safety for patients, for example in highlighting allergies to medicines,” he said.
Use of the SCR began to take off in hospitals in 2010 and since then almost three quarters of the population, 41.9 million people, now have an SCR on the national database, Spine, said Emyr Jones, the clinical ambassador for the SCR at the HSCIC. “That number is growing by about a million a month,” he said.
Access to the SCR in hospital pharmacy departments was largely being driven by pharmacy technicians, said Hussain.
The SCR contains limited patient information that is extracted from the GP record and does not allow other healthcare professionals to add their own notes. Eventually, the SCR may contain extra fields of data and allow pharmacists to add their own information, but this won’t be until it becomes “business as usual” for pharmacists to use the SCR, explained Jones. “We are starting small and simple and expanding once everyone has confidence in the system,” he said.
Patient representatives expressed concerns about the security of their information and the implied consent process model, which means patients have to opt out if they do not want their data shared.
Jones said the implied consent model is robust and has been approved by Fiona Caldicott, who wrote the guiding principles on sharing patient’s information.
But Kiron Kurien, a patient group spokesperson, expressed concerns about data access. She said that after being referred for physiotherapy she had been called by a private physiotherapy company offering her treatment and that she wanted to know how this breach of confidentiality had been able to happen.
Kurien told the meeting that patients feared they would lose control of their personal information without gaining a discernable improvement in care. “Patients want data security and control over where and who their data is shared with,” she said. “Patients want improved service options, for example health checks and vaccinations in the pharmacy.”
Jones countered concerns over security by explaining that the SCR was only accessible through a secure data cable and a smartcard held by healthcare professionals, and through the requirement that each organisation needed to have a privacy officer that monitored the use of data.
In certain parts of London, however, access to records has gone much further than the SCR and there was a warning from a GP that it could be moving too fast. “In my area of West London all the GP practices and one out of two hospital trusts is using technology called Wholesystem,” said James Cavanagh, who also sits on a clinical commissioning group. “This allows every healthcare professional who is linked into the system to view the entire history of the patient’s GP medical record and to write to it.”
“I don’t believe implied consent is actual consent and if a pharmacist sees personal information about a patient that the patient didn’t want them to see, it is the GP that would take the blame,” he added.
Cavanagh explained that he is not against sharing records in principle, but is concerned about model of patient consent. But Jones challenged this and said that even if a pharmacist did see information that the patient didn’t want them to it shouldn’t matter, because pharmacists are healthcare professionals bound by the same professional principles as doctors. “I don’t see any difference between pharmacists and doctors,” he said.