Recommendation 244

Electronic patient records systems

Accepted
There is a need for all to accept common information practices, and to feed performance information into shared databases for monitoring purposes. The following principles should be applied in considering the introduction of electronic patient information systems:

  • patients need to be granted user friendly, real time and retrospective access to read their records, and a facility to enter comments. They should be enabled to have a copy of records in a form useable by them, if they wish to have one. If possible, the summary care record should be made accessible in this way.
  • systems should be designed to include prompts and defaults where these will contribute to safe and effective care, and to accurate recording of information on first entry.
  • systems should include a facility to alert supervisors where actions which might be expected have not occurred, or where likely inaccuracies have been entered.
  • systems should, where practicable and proportionate, be capable of collecting performance management and audit information automatically, appropriately anonymised direct from entries, to avoid unnecessary duplication of input.
  • systems must be designed by healthcare professionals in partnership with patient groups to secure maximum professional and patient engagement in ensuring accuracy, utility and relevance, both to the needs of the individual patients and collective professional, managerial and regulatory requirements.

Systems must be capable of reflecting changing needs and local requirements over and above nationally required minimum standards.

There is both a need for common information practices that support the extraction of data to central systems to support improvements in data quality and service provision, and a need for electronic patient systems.

The Health and Social Care Act 2012 gives the Secretary of State for Health and NHS England powers to publish, or adopt, data standards that specify how data should be processed.  To support this work the Health and Social Care Information Centre also publishes performance information and statistics, using transparent calculations, so that they can be used across the health and care system. The Health and Social Care Information Centre’s Indicator Portal which will extend this service.

Access to the summary care record is being rolled out across England and we will assess options for making them more accessible electronically.

We also agree that patients should have access to their own records.  By spring 2015 every patient will be able to see their records, test results, book appointments and order repeat prescriptions online. See Everyone Counts: Planning for Patients 2013/14.  Patients will also be able to communicate with their practice electronically as outlined in the Power of Information.

While we expect practices to make patients’ records available online as fully possible, some practices will only be able to make records available from a specific date due to the way the records were stored originally.

The Department of Health is committed to connecting existing systems rather than expecting every organisation to use the same technology, see Liberating the NHS: An Information Revolution and the Power of Information.  As such, GP practices will set specific requirements for electronic patient records locally, based on national standards to ensure that information can be shared across the system.  As such it is for local organisations to consider the substance of the points raised in this recommendation in that light.

Some national standards have already been set, including the use of the NHS number, and further standards will be included in NHS England’s Technology Strategy, which is due to be published in early 2014.

As part of NHS England’s publication Safer Hospitals, Safer Wards: Achieving an Integrated Digital Care Record, it announced a £260m technology fund that can be used by NHS foundation trusts and NHS trusts to progress their activities to replace paper based systems for patient notes with integrated digital care records.  NHS organisations can also apply for funding to support them improve efficiency, quality and safety by introducing ePrescribing systems.

Update

Access to the Summary Care Record is progressing well with just over 40 million records available and NHS England is leading work to ensure a third of Accident and Emergency Services, 111 Services and Ambulance Services will have access to Summary Care Records by 2015. NHS England’s business plan for 2014/15 – 2016/2017 also outlines a key deliverable that online access to GP records would be available in 95% of GP practices from March 2015.

The timescales for an NHS England Technology Strategy have been impacted by the development of a National Information Board Framework which covers the whole of the health and care system and all of the arms-length bodies.

The criticality of NHS number and delivery via a standards-based approach to enable interoperability and exchange of data is pivotal in the National Information Board Framework, which was published in November. NHS England will then publish its Technology and Data Strategy for which the use of NHS Number and a standards-based approach will again be vital.

The intention is to put citizens in control of the decisions about their own healthcare and how they access services, be it online access to their medical record; online booking of services e.g. appointments and repeat prescriptions and access to trusted NHS “apps” and social networks.