Sunday, March 09, 2008

Electronic Patient Records

I said I would return to the subject of the introduction electronic patient records in the National Health Service.

I will nail my colours to the mast from the outset – I am a great fan of electronic notes. I actually believe most clinicians working in the NHS are also fans in principle.

I look forward to an electronic system that means wherever I am as a patient in the UK (or indeed wherever I am in the world) the health professionals involved in my care can log in and see my health record wherever I happen to be. I am convinced this will improve patient safety and could save lives.

The main concerns appear to be about security of information and whether our information is safe or not.

This has been highlighted in recent scandals in other government departments such as the Tax Office and Child Benefit where CD’s containing personal information have apparently been ‘lost.’

It goes without saying we need to make sure there are strict safeguards built in to the NHS electronic patient records system to ensure no such ‘accidents’ happen with our personal health records.

I certainly do not want a system that is so insecure that my health records may end up for public viewing!

There are also concerns about who will have access to view patient’s notes within the NHS. Will all staff for instance have access to all patients’ notes? The short answer is no. Modern software easily enables restricted access and the issue of access to non clinical staff is less of a security risk than we currently have with paper notes.

I will share a story to illustrate my point.

When I was 16 years of age I joined the NHS straight from school as a
very junior clerk. One of my first jobs was in the medical records department. As a 16 year old - and very green around the ears - I had total access to all the patients’ notes of that particular hospital. That is how secure/insecure patient’s paper notes are in reality in a hospital. So the idea that paper records are more secure than electronic records is totally flawed in my opinion.

Also there are numerous examples over the years of paper notes ‘getting lost.’

I share concerns of all who worry about the security implications. I think we have to make sure whatever electronic system the NHS finally plumps for gives the patients the guarantees they need about security.

I hope patients support the principle of the electronic record because this is definitely the way forward.


Richard Lipscombe said...

Simplicity and internet based patient information are synonymous.

There is no human enterprise on earth in more need of Simplicity than the world's health care systems. So this development has to be welcomed wholeheartedly.

What Google, GE, and others are already doing with web-based patient information systems will impressively simplify the patient doctor/hospital experience. It will save lives, it will dramatically reduce rework (ie doctors error and repeat procedures) it will lower cost, it will increase the quality of health care being delivered around the globe - there is no doubt about it.

Health care is about to join the C21st. As with all major changes and attempts at Simplicity there will be setbacks and some things will remain problematic. But some giant strides towards Simplicity in health care are about to be made.

Security should not be a technical issue but it will always remain a people issue - if people want to abuse security protocols they will find a way to do it.

The more important issue is patient PRIVACY... It is an issue because patients by and large have not had control of their personal medical history/records in the antiquated Doctor's Notes system.

The issue of Privacy is a not a big one for most people today or ever - as most of their health/illness information is told to the public by them anyway. But there are "secrets" that must be kept and these have to kept in the new system at least as well as it was in the old.

Indeed given the scrutiny of our health in our many roles in life today - worker, lover, partner, parent, child, etc - we have to be able to keep some information confidential.

As stem cell medicine or genetic based diagnosis and prognosis become more common the privacy of a patient's information will become a key issue.

Anonymous said...

I'm not too bothered about some nosey clerk in the doctor's practice having a sneaky look at my record to see why I came in to the surgery holding my left arm. What I am seriously worried about is:

The surgery writing my records onto removable media and losing that media.

My records being sold (legally or illegally) to any commercial organisation without my permission.

Any disclosure about my health status to anyone other than those involved in any medical care I may need.

Richard Lipscombe said...

Interesting concerns Mark - those three things, of course, can all happen now (and probably do)...

The real advantage of the next generation of health care records is that the patient rather than the doctor or hospital administration can/will essentially be in control of his or her PRIVACY around health care issues...

I understand that these changes will not suit everyone in every circumstance but they will lower costs and they will definitely underpin better health/wellness outcomes...

The issues you raise may be of more concern in the future (within the next decade or two) - not because the nature of records access, storage, or convenience is changed but because the interest of "other parties" in your/ones health issues is heightened.

When genetic traits are able to be detected, patterned, and mapped then they obviously become the basis of future health diagnosis and prognosis - once such genetic information becomes generally available then it is reasonable to expect that these "other parties" might become more interested than they should in ones health care records....

Regrettably, the more things change the more things stay the same....

Trevor Gay said...

Hi Mark - We agree on one point and disagree on another. I fully agree with you and share your anxieties about the security implications you mention. Actually I am equally concerned about the security of my current paper held records.

Where we diverge is that I am VERY CONCERNED about unauthorised ‘nosey people’ reading my notes whether they are receptionists or clinicians who have NO NEED AND NO RIGHT to look at my records. My notes are not for the entertainment and titillation of staff – they are confidential notes between ONLY me and the clinician treating me. Once we say we don’t care who sees notes we might as well publish them in newspapers. This is an important principle. With the IT software electronic systems show 'footprints' left to prove who has accessed patient records.

Unauthorised reading of patient’s records is gross misconduct and should result in dismissal of the offending staff member - there is no defence for that - it is a sacred principle worth fighting for.

Trevor Gay said...

Richard – thanks for you comments – brilliant as always!

I agree with you and I look forward to the day when patients hold their own record and own that record. That will come in the UK in the next 5 years I am sure for those who want to take that step.

Interestingly I remember over 12 years ago when parent held records were introduced for health visiting in the area I was working. This meant new parents held the patient record for their child’s health development rather than the health visitor who had previously held the record. At the same time some research was done in Oxford, England that found more records were lost by professionals than by parents over a 12 month audit period - only a subjective anecdote but it illustrates a lot to me.

Anonymous said...

Electronic medical patient record are more accurate, and easier to maintain and can store more information than those written by hand.They save a lot of time, as the required medical data is easily obtainable by the push of a button.