NHS reforms could unravel SCRs

The paper, Equity and Excellence: Liberating the NHS , states that patients should have more control over electronic health records and be able to determine who else can access them, but the Department of Health has not yet outlined specific plans for a new system. Health minister Simon Burns announced in June that summary care records (SCRs) were under review amidst concerns about data security. He outlined plans to move to "a focus of ownership of information". However, the white paper strongly advocates the sharing of patient information with third parties, which would include private sector companies. "The patient will determine who else can access their records and will easily be able to see changes when they are made to their records. We will consult on arrangements, including appropriate confidentiality safeguards, later this year," says the paper. Both coalition parties' vocal dislike of SCRs, which were developed under the National Programme for IT (NPfIT), point to the current system being replaced. The potential scrapping of the database means that the government would have to replace it with a stronger model with enhanced security measures. Victor Almeida, healthcare analyst at Kable, believes this could create opportunities for firms providing data and authentication, as well as those providing cloud computing services, as clinicians will want cheaper and simpler ways of handling patient data. The abolition of primary care trusts (PCTs) and strategic health authorities as part of the reforms is also set to have a notable impact on the care records service (CRS), due to the increased controls that GPs will have. "About half of the CRS contracts are held by PCTs," points out Almeida. "It is likely that the majority of GP consortia will probably go for an alternative and more innovative solution from a supplier of their choice, although they will have the choice to keep their existing systems." He envisages that the care records service will move to a local level and trusts will decide which electronic health record applications they really need. The government's openness to private sector involvement could also see the creation of a competitive environment involving companies that want to host patient information online. Prime minister David Cameron, while in opposition, praised the concept of personal health records including Microsoft HealthVault and Google Health as an alternative to central NHS databases. When originally unveiled by the Tories in 2009, the idea triggered warnings from MPs that hackers would be able to access the personal details of patients – the same security criticisms that have dogged the current central database. The white paper revealed that a newly created NHS Commissioning Board will take responsibility for data security. With health secretary Andrew Lansley calling for extensive data sharing alongside a need to cut bureaucracy and administrative costs, there are also some budget problems the government may face. "GPs may also require data dissemination and data analysis support services, as they are not accustomed to the various requirements and funding and procurement," Almeida points out. Critics of Lansley's plans have said that GPs may need to spend substantial amounts for adequate administrative support, which would include patient data and information services. But the government has said that although it wants to give patients more information and control over data, it wants to spend less doing it. Despite the coalition's opposition to the current electronic database, shortly after the election the government announced that trusts and GPs would still continue to add names to the SCR system. The British Medical Association (BMA) has consistently opposed SCRs and has said that the electronic records of many people have been uploaded without patients' knowledge. A spokesperson for the association told SmartHealthcare.com that it would like the government to halt summary care records and put in place a model that places more weight on patient consent. "In an ideal world, there would be a consent model in place that enables explicit consent, rather than indicating an opt out," the spokesperson said, adding that England has been too ambitious with electronic records and should look at the Scottish emergency care summary system, which only holds basic patient information. A recent report by University College London found that 85% of people it surveyed had thrown away summary care record opt out letters due to the complicated nature of the forms. With the government set to make an announcement within weeks about changes to NPfIT, GPs and NHS staff do not have much longer to wait to see how the coalition plans to tackle electronic health records.