Electronic record benefits modest

Thursday, June 17, 2010

The benefits of the Summary Care Record (SCR) – an electronic summary of a patient's healthcare data – are more modest than anticipated.

According to a study published on bmj.com, the SCR appears to have had a slow start, with very low levels of access by clinicians when it is available.

Researchers from University College London set out to evaluate the SCR scheme between 2007 and 2010. They analysed data across three sites, including over 400,000 encounters in participating primary care out-of-hours and walk-in-centres and 140 interviews with policymakers, managers, clinicians and software suppliers involved in the scheme.

By early 2010, 1.5 million SCRs had been created, but the researchers found that creating SCRs and supporting their adoption and use was a complex, technically challenging and labour-intensive process which occurred much more slowly than originally planned.

Before an SCR is created, a letter is sent informing the patient of this action. But the study found 88 per cent of patients who had received letters had either "thrown them away unread or could not remember receiving them".

In participating primary care out-of-hours and walk-in centres, the research revealed that once an SCR was created, it was accessed in 21 per cent of all encounters. This figure was rising in some but not all sites, the study said.

The study also found wide variations in the amount of times individual clinicians accessed SCRs when available. The study found some did not access it at all, while others accessed it 84 per cent of the time. The variation was put down to the setting, the type of clinician and their level of experience.

On a more positive note, the study found that when the SCR was accessed, it appeared to support better quality care and increased clinicians' confidence in some encounters. While there were no actual increases in patient safety, the study said findings were consistent with a positive impact on preventing medication errors.

Data accuracy was also addressed by the study, due to concerns that human mistakes could cause problems in the future when treating patients. Whilst the study identified some incomplete or inaccurate data, no cases were seen where harm was caused because of it. The study found doctors often used their own judgement when using the data and also utilised other sources of information.

The evaluation also showed that the successful introduction of SCRs required collaboration between stakeholders from different worlds, with different values, priorities, and ways of working. The study said these differences may have accounted for many of the misunderstandings and frictions occurring at the operational level. It has suggested that the programme's fortunes will depend on the ability "to bridge the different institutional worlds of different stakeholders, align their conflicting logics, and mobilise implementation effort".

"This evaluation has shown that some progress has been made in introducing shared electronic summary records in England and that some benefits have occurred. However, significant social and technical barriers to the widespread adoption and use of such records remain and their benefits to date appear more subtle and contingent than early policy documents predicted," it concluded.

Dr Laurence Buckman, chairman of the British Medical Association's GP Committee, said: "While the BMA does not oppose shared electronic patient records in principle, we have long voiced concerns about the way this programme has been implemented. It should not have been rolled out ahead of the findings of this evaluation – which uncovers some very serious issues - being published."

Phil Booth, national coordinator of NO2ID, said: "Independent research indicates that 26 million people had no idea that one item of colourful junk mail was their only official warning of massive changes to their families' medical privacy. They have been kept in the dark, and have no real choice. They may not even find out until it is too late.

"This is not a mistake. It is deliberate abuse. Yet ministers who say they'll put patients in control are happy to let it continue. Uploads must stop now."