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The spy in the GP's surgery
http://www.timesonline.co.uk/article...435976,00.html The spy in the GP's surgery Alice Miles FOR SOME reason, there has been a lot more fuss about identity cards than about the electronic patient record. The what? Quite. The NHS's electronic patient record is already up and running. It contains basic demographic data - name, address, date of birth - for every person in the country. This year the system will "go live", area by area, with more and more of a patient's personal medical record added to it. It will be far more intrusive than an ID card. And hundreds of thousands of NHS employees will have access to it. Wave bye bye to patient confidentiality. No system with that many users can be secure. You may not even know it is happening. Local advertising campaigns will alert patients that the system is starting up in their area. If you fail to notice the adverts, your GP is under no obligation to inform you that he is about to post your most private details online. The patient record programme - which will include new information, but not existing records - is part of the £6.2-billion IT system being built to cover the whole NHS. It is the biggest civil IT programme in the world, could eventually cost up to £30 billion and will link 240 hospitals, 8,000 surgeries, 100,000 doctors and 380,000 nurses on the internet, enabling computerised appointment bookings, an electronic X-ray archive and online repeat prescriptions (eventually, maybe). The electronic patient record forms a major part of the system. It "sits on the spine", as one official put it. Officials at the Department of Health and seconded techies from the private sector are building in a range of "security" measures. Hospital staff will have to prove their identity, for example, before being registered to use the system, and they will need a password to gain access. Anyone who reads or changes a patient's record will automatically be logged. Which doesn't sound any more secure than your average company IT system, with their "spare " log-ins and generic passwords. Given the number of temporary staff employed by the NHS, this system will sooner or later leak like a sieve. Family doctors' leaders have already said that they fear patient confidentiality will be compromised and that their workload will increase. GPs, like everyone, hate change. It should work like this: the GP will make his or her notes, parts of which will then be extracted on to the "spine" - major conditions, prescriptions, allergies, etc. All hospital treatment will go on to the spine as well. This should mean a faster, more efficient service for patients: fewer referral letters, no more brown envelopes overflowing with medical records, X-ray results available online, and repeat prescriptions issued at the touch of a button. That is if - and it's a big if, given the Government's lamentable record with large IT projects - it works. Thankfully, if you don't trust the system you can opt out. You will, though, be automatically included unless you say you want to opt out, in which case all your records will remain with your GP. Hence the importance of catching the announcement that the electronic record is starting in your area. A further security system is planned. All patients will be allowed a "sealed envelope" into which will be placed any information that they want to be kept confidential. It can be opened only in the event of an emergency: for example, when a patient is incapacitated and unable to give consent. What will you put in your envelope? And how pleased is your doctor going to be when you, the patient, decide that you are happy for one piece of information to go on "the spine" , would like another one in the "sealed envelope", but prefer your conversation with the GP to be kept in his notes only? And at which point in the chain - when you go to your GP, when he takes a swab, when the results are returned (electronically, presumably) - do you, the patient, decide that, actually, that's a little embarrassing. Could I put this whole episode into the sealed envelope, please? An unresolved issue has already arisen over whether a patient may put in the sealed envelope a condition - for instance, being HIV positive - which it may be a danger to other people, such as a surgeon, not to know. Who, in the end, owns a patient's notes? The security will rely not only upon thousands of hospital workers, many of them temporary, but upon GPs and their staff to co-operate with patients' wishes. And if there's one thing a GP hates more than a government diktat, it's an order from a patient. There is an alternative that would give patients flexibility, control and choice. This would be to put records on to an electronic card that could be read by NHS computers around the country, keep a back-up for safety - then let the patient carry the card with him. He wouldn't be able to change it, but he would own it. And with it he could visit any surgery, instead of being tied to a single one that doesn't open in the evenings and is nowhere near his office. It would be up to the patient not to be moronic and to take the card with him when he has a hospital or doctor's appointment (to deal with the objection of one GP who suggested that patients are too stupid to remember). Senior ministers are desperate to break the grip of GPs over the NHS. Unreformed family doctor services run for the convenience of GPs and not that of patients are responsible for much dissatisfaction with the health service - unsurprisingly, as there are between 6 and 7 million operations a year, some 12 million attendances at accident and emergency and 300 million GP appointments. But ministers, afraid of confrontation with GPs, are pussyfooting around the threat of allowing the private sector into the family doctor's surgery. So why not let patients make the choices for them? Give them their records and they can take their business where they wish. The visit can be logged electronically and charged to the primary care trust responsible for that patient. Information is power. Which is why government and the NHS will always try to hug it all to themselves. |
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