Two GPs from the Basque Country in northern Spain have been suspended without pay, apparently for refusing to use a centralised database of patient records, writes SA Mathieson.

The Basque health service, Osakidetza, last year implemented a central database called Osabide. According to Dr Juan Gérvas, a Madrid doctor and visiting professor at Baltimore’s Johns Hopkins University, Dr Ángel Ruiz Téllez and Dr Paz Pérez Gortari of the Sansomendi health centre in Vitoria put up a notice in their waiting room warning of the database, and refused to transfer records from their old system.

The notice concluded, “Considero mi deber informarles de que dicho cambio se hace sin mi autorización, ni con la suya, por lo que yo no asumo los perjuicios y molestias que esta medida pueda suponer [I consider my duty to inform you that the transfer has neither my permission nor yours, and I cannot assume the damage and trouble this initiative can produce to you].”

This March, the two doctors were suspended without pay for two years and details of their case have been widely circulated. Dr Gérvas is campaigning for the two doctors to be reinstated.

“Managers and politicians in Osakidetza are resisting a formidable pressure, national and international,” he said in an email to E-Health Insider this week. “Good news is the clear adoption of a favourable position to both doctors of the General Council of Spanish Physicians, which understands it is not a local problem, but a general problem about confidentiality and security.”

He says that the database, for which no permission was asked or given by GPs or patients, includes an option to mark episodes as confidential. But sorting through years of records to find all those that should be kept secret would be near-impossible, he adds.

Dr Gérvas says that he has never heard of such a harsh penalty in almost 30 years of working in the Spanish national health service, with doctors found guilty of working while drunk being punished with more leniency. The two doctors did not reply to e-mails as E-Health Insider went to press.

In England, the NHS Information Authority has been consulting on confidentiality issues raised by IT, including centralised data storage. It is in the middle of a major consultation exercise to explore on how patient identifiable information could be shared more widely and beneficially between authorised users in the NHS while respecting patient privacy. The authority has been working with the idea of keeping highly sensitive information in a “virtual sealed envelope” in each record. This would be guarded closely under new information governance arrangements and normally opened only with the patient’s permission.

First results from the research, published in March, suggest that
60% of patients would not want to put anything in a virtual sealed envelope, 25% thought they might put a little bit of information in it and 8% definitely had privacy issues, for example around sexually transmitted diseases, mental health problems and genetic predispositions.

Dr Paul Cundy, the BMA’s spokesperson on computing and general practice and a London GP, says that patients have already asked him not to allow their records outside the surgery, having read about the possibility of patient record databases in the media.

“The views of patients on centralised records are very negative,” he says. “They want their GP to hold their record, and no-one else to look at it except on an event-by-event, consent-driven process.”

Dr Cundy says that his surgery keeps all records on the premises, adding that he recognises there are economies of scale relating to record storage costs, but that he would only allow them to be kept elsewhere if he had total control over their usage.

“If GPs don’t have confidence that their records are to be treated with the appropriate security, they just won’t use those systems,” he concludes.

Centralised systems should provide advantages to patients with records made available easily in emergencies, providing information on allergic reactions to drugs, or conditions such as haemophilia. On a less life-threatening level, central repositories could make it easier to consult a GP away from home.

(c) SA Mathieson 2003