PATIENT RECORDS
to see a little of this philosophy in action. Lewis had commissioned Oasis Medical Solutions (providers of the hospital’s patient systems) to design and build a system to support the hospital’s annual 215,000 outpatient visits. The new system links into the main patient record system and was delivered on time earlier this year. I watched as patients arriving at their clinic were able to register their arrival at a small kiosk with a touch screen, just like using an ATM at the bank. There was an option to engage with a receptionist but, just as in a bank, most patients preferred to use the screen.
Their name was then added to a list of patients ready for their appointment. This list was displayed in the waiting area and gave patients information about their relative position in the queue and reassurance that, if they were sent for tests in another department, they would not be forgotten or have their appointment delayed.
Up-to-date
The part of the system I couldn’t see was patient records being updated by clinicians in real time. Lewis stressed the benefi ts in accuracy and completeness of entering data into the system as close as possible to the point of contact between patient and clinician.
My trip to Guildford and my meeting with Lewis were coming to an end. I couldn’t resist one more question however.
“Is
there a big difference between delivering technology supported change programmes in the NHS compared with doing it in the private sector?”
“Yes,” he said, “visibility. In the private sector, we could often plan and prepare change behind the business screen. In the NHS, as in other public services, quite rightly everything is done in public and there is an audience with a natural and open interest in the outcome.
“I sometimes feel like Rolf Harris in the days he painted his giant canvases with large brushes, live on children’s television. Only when he added the fi nal splashes of light and shade could we, the audience, fully appreciate the big picture.”
I will keep in my mind for some time the image of Peter Lewis painting information systems in front of a live audience.
FOR MORE INFORMATION Visit
www.oasismedicalsolutions.com
Research published by Stephen Whitehead of the New Economics Foundation reveals public attitudes towards electronic patient records.
F
rom 2009-10, The Wellcome Trust funded nef (the new economics foundation) and the Centre for Science Education at Sheffi eld Hallam University to undertake a mass public engagement exercise on digitising patient records.
The researchers engaged with 6,000 people across England to discover what they thought about privacy and security issues, and ended up recommending the introduction of a ‘social contract’ to permit the use of personal data for projects of public benefi t, while ensuring that public trust in medical confi dentiality is not jeopardised.
The report, ‘Who Sees What: Exploring public views on personal electronic health records’, also made a number of other recommendations: a consent-based opt out system from the database itself; that explicit consent be needed to share details with a wide range of clinical professionals; that non-medical staff should not have access to identifi able patient information in any form; that patients should get a ‘right to review’ – but not necessarily from home; that the practice of sharing identifi able data for research without consent should be reviewed; that patients should be able to see an ‘audit trail’ of who has accessed their data; and that the organisations responsible for collecting and managing the data involve patients in the process and respect their views.
Report author Stephen Whitehead wrote: “On the issue of consent for the creation of records, we found that there is a strongly held public feeling that there ought to be a right to opt out of any database. 80% of adults and 86% of young people supported some form of consent. For 67% of adults and 59% of young people this means a more robust consent mechanism than the one currently offered in Summary Care Records.
“Public enthusiasm for the strong public education function of the explicit consent model was tempered by an awareness of the high level of resources that it would
require, making it, in the view of most, impractical.
“On the use of patient data, we found enthusiasm for the potential of electronic patient record systems to offer benefi ts to treatment and healthcare amongst 57% of adults and 67% of young people. However, this was tempered by a wariness around sharing identifi able personal data with non-clinical staff. Rather than a ‘consent to view’ system, many respondents indicated that they wanted an open set of audit trails so that patients could review all accesses to their information, whether or not they were present.
“92% of adults and 97% of young people backed giving patients access to their records. However, only 35% of adults and 36% of young people backed home access and only 11% and 13% backed allowing patients to add additional information to their records. 57% of young people backed the NHS’s role in supporting medical research and 74% of adults supported the use of electronic patient records for this purpose.
“However, 79% of adults and 74% of young people felt that consent was required for sharing identifi able data with researchers and 34% and 56% respectively extended this to the sharing of anonymised data. There was also some opposition to extending the range of people who had direct access to patient records in order to facilitate the recruitment of participants for clinical trials, with only 34% of adults and 10% of young people favouring this approach.”
The fi ndings of the report have fed into the Department of Health’s decision-making process on how to proceed with the under fi re electronic patient record programme rollout.
The full report is at
tinyurl.com/44k9pea Stephen Whitehead
FOR MORE INFORMATION national health executive May/Jun 11 | 29
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