The Summary Care Record - ICMCC

The Summary Care Record - ICMCC

Summary Care Record & HealthSpace

Better information for better, safer care

Manpreet Pujara

GP National Clinical Lead

The Summary Care Record

Strategic Objective:

“To ensure that patients can be confident that the NHS professionals caring for them

have reliable and rapid access, 24 hours a day, to the relevant personal information

necessary to support their care”

Information for Health, An Information Strategy for the Modern NHS, 1998 – 2005, DOH

• An electronic summary of key health information available to any

NHS healthcare professional treating a patient in England

• Particularly crucial in unscheduled care settings

• It will hold limited essential information derived from the patients

electronic medical records

• Medication

• Allergies

• Significant medical history


The Summary Care Record

Summary Care Record Vision:

The NHS Summary Care Record will support unscheduled care settings, providing

information to support care where no information is currently held about a patient, for

example in emergency departments, primary care out-of-hours settings, treating

temporary residents, and emergency admissions to secondary care.”


• Will remain a Summary Record

• Contains only significant aspects of a person’s care

• Accumulates new key items of the person’s care as time goes by

• Derived from records of organisations delivering care to that patient

• Initially populated by General Practice contribution

• Patients will be able to see the record via HealthSpace


Summary Vs Detailed Care Record

Summary and Detailed Care Records:

The NHS CRS is made up of two separate, yet at the same time integrated, elements:

• Detailed Records – held locally by different providers of care e.g. GP, Acute Hospital,

Community Hospital etc

Summary Care Record- held nationally on a database and populated by contributions from

detailed, locally held records.

Why have a Summary Care Record?

1. Patients will have access to their own Summary Care Record

2. Patients will be able to decide whether or not they want a Summary

Care Record.

3. A patient’s Summary Care Record will be nationally available to any

clinician who has a legitimate relationship with a patient.

4. The Summary Care Record will begin to join up care at a local level in

advance of local detailed records becoming integrated.

5. Increasing plurality of care, there will always be providers of NHS care

who do not have locally integrated systems


The case for the Summary Care Record


• 9 million patients approx are seen every year by OOH Services

• 18 million patients approx seen in A&E, MIU per annum

• 40% of emergency calls attended result in admission, whilst at

least 50% of these could be cared for at the scene or in the


• 1 in 16 hospital admissions are the result of an Adverse Drug

Reaction (72% avoidable)

• Adverse Drug Reactions as a cause of hospital admission cost

the NHS £466m pa

What about all the controversy?

Can patients refuse to have a summary?

• Yes !

Can patients change their minds at any stage?

• Yes!

Can patients limit what is shared?

• Yes!

Ensuring confidentiality and access

• Role Based Access Control (RBAC)

• Legitimate Relationships

• Audit and alerts

• Physical Security

Options for Patients




Clinician - via SCR:

A Summary Care Record is,

visible to an authorised user who

has a Legitimate Relationship to

that patient.

Clinician - via SCR:

A Summary Care Record will exist

but will not be automatically visible

to any authorised user.

The patient may give a Clinician

permission to override the share

status and view the record.

The status can only be overridden

without a patients permission by a

court order or statute.

Clinician - via SCR:

A blank summary is created,

stating that the patient did not want

to have a summary record. Even if

the consent status is changed to

Share, no data is available to be


Patient – via HealthSpace:

The patients Summary Care

Record, visible to that patient

Patient – via HealthSpace:

The patients Summary Care

Record, visible to that patient

Patient – via HealthSpace:

No clinical data is available. A

note confirming this choice is




What is the consenting process?

• Public information leaflet to patients with plenty of notice of what

is happening and opportunity to find out more and refuse to have

SCR if that is their wish

• Letters customised and sent to every adult over 16

• Dedicated NHS Direct care Records service Information Line

• Local Information Centres for more information and


• Local input into voluntary organisations and difficult to reach


The early adopter programme

• 10% technology

• 90%

• Business change

• Understanding

• Growing in confidence

• Time line governed by PCT and practice readiness

and not by technology

The Early Adopter Programme

• Six Primary Care Trusts engaged totalling 2 Million potential


• Drugs and allergies under implicit consent

• Data accreditation required for quality and paper-lite status before

practice can submit patient data to the SCR programme

• Minimum data set of significant medical history, immunisations

and alerts for colleagues sent after patients agreement (Phase 2)

Progress to Date

• 614,000 patients mailed so far and over 153,000 records loaded

to the Spine

• 4961 (0.81%) of mailed patients do not want a Summary Care

Record. 154 (0.03%) don’t want their data shared

• 280 accesses to SCR to date

• Information Line and Information Centres were quiet

• Most patients thought that electronic sharing was already in place

and want the NHS to get on with it

• Main area of concern is security but patients satisfied with

controls in place

• Patients very keen on accessing their records through


• INPS and iSoft have delivered their solutions – EMIS and TPP

have committed to delivery in 2008

What’s Next over next 6 months?

• General Practice

The protocols for additional significant information after

discussion with patients

• Out of Hours

• Ensuring smooth access to SCR in busy settings

• A/E

• as critical mass of patients on line enabling access

• Community Settings

• Enabling mobile access to SCR with IG controls

• Caldicott Guardians

• Ensuring that the tools provided for them are appropriate for

their needs

What’s Next over next 24 months?

• Extra functionality that will enable central recording of

NO store on the spine

• Ability to receive outpatient letters and discharge

reports from other settings

• Sealed envelopes to hide sensitive information

• Improved interfaces on browser to SCR

• Knowledge support that is context sensitive launched

from coded entries on SCR & HealthSpace

HealthSpace Strategy

Information for better, safer care and greater


What is HealthSpace

Secure on line domain for patients for their

transactions with the Health Service

Offered through the Choices Portal

Through high level registration authentication

and authentication services can be offered to

patients across a range of work streams

The case for the HealthSpace


• Patient access to information leads to control

• Partnership between patients and clinicians in management of


• Resultant change in dynamic of service delivery


Better Information, better choices, better health: Putting information at the centre of health: DH

Dec 2004

Pyper et al 2001; Pyper et al 2004; Ward and Innes 2003

(Cimino et al 2002; Harris 2004; Pyper et al 2004; Winkelman et al 2005

Patient access through Healthspace

• Registration started already for Early Adopters

• E-gif level 2.5

• Access to SCR

• Can view their consent status

• From 2008A will be able to view SCR even if

dissented to sharing

• Potential of coded entries to hyperlink to knowledge

support and leaflets

View and store clinical information

about themselves


Renal patient view piloting in Salford

Diabetes record piloting in Salford

Can choose to have letters about themselves

copied to their HealthSpace account rather than

through the mail

HealthSpace – the Future

HealthSpace sets the portal and security standard through

which other patient records can be enabled for patient


The full GP record where the GP wishes to make it

available to patients

Patients can store URL pointers to abnormal scan/x ray


The coded information in both Summary Care Record and

GP records enable context sensitive knowledge support

through on line access to approved databases and



Enables a secure communication channel between

patients and clinicians

This can enable updates to records both

demographic and clinical and many of the

features that follow

The email addresses of both the clinician and

the user remain hidden and communication is

managed through webforms in HealthSpace and

underpinned by NHS mail

Can enable better continuity of care as patients

are able to exploit this medium for support if they

are unable to see the clinician.

• Time zone management if patient abroad

• Enables patients who otherwise may feel it is

too risky to travel if they cannot keep in touch

with their clinical team

Ordering repeat prescriptions

•From GP

• From pharmacist

Patient and service experience enhanced as clear

communication enabled and securely recorded

Patient sending information to their

clinician and records – Self Care

Regular monitoring of physiological measures

sent directly to clinical records

Ability to send digital photo of their progress say

in ulcer management

Ability to receive back advice on medication

levels following the sending of information

Receive information securely

If chosen as medium for communication

HealthSpace can be used for

Screening reminders

Opportunity for patients to ask for information of

relevance to their conditions to be sent to them

• Sending opportunities to help with research

• Conferences and self help groups

Enables patients to contribute to


Ability to fill in pre consultation questionnaires

Send choices regarding advanced directives

Preferences when in hospital setting eg gender

of clinician, dietary requirements, pastoral


Organ donor consent status


Make appointments directly with the


Choose and book which enables authorised

secondary care appointment booking directly by

the patient

Direct access to appointments in primary care

through the HealthSpace portal into GP and

other systems

Privacy and Security

Assures secure access

View alerts generated within SCR

Check consent status

Approve carers to have access

Limit carers view of HealthSpace against filters

View who has last logged onto HealthSpace and


Potential business reengineering as a


Cognitive behavioural therapy on line with

results directly back to clinician

INR monitoring and results directly back to


Managing larger case load as work smarter with

e consultations in the mix

Case conferences chaired by patient with key

actions posted by patient into their section of



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