Universal CRS sheds bright light on old issues

Many of the questions raised by electronic records are not new, but their universal nature sheds a bright light on current practice, according to Harry Cayton, chair of the Care Record Development Board (CRDB).

“You find some very murky and dusty areas of practice,” he added in a presentation to the New Frontiers conference on clinical information systems in London last week.

He was referring to questions around controlling access to records and confidentiality. “The systems we are building and the way we intend to use the record is designed to enhance confidentiality,” he said.

Cayton listed the benefits of the planned national care record including improved patient safety, greater accuracy and increased efficiency and control and said it was “absolutely in pursuit of these benefits” that the CRDB carried out its work.

He took some professionals to task for suggesting in media reports that the system could be used by jilted spouses to track down ex-partners and murder them and for suggesting that information sharing without patient consent was tantamount to date rape.

“Those professionals who enter this debate should enter on the basis of knowledge of what is being created and how it will be used,” he said.

He spoke about the design features which would limit access to records or, in a few cases, allow patients to opt out, but Cayton said he was committed to building a system that was so well designed and so well understood that that people would want to use it.

A representative from the Scottish Executive, Vanessa Gaskell, said they had been advised that entering the system was “all or nothing” and it was not possible to opt out in the way Cayton described.

Cayton said clinicians had a duty to record data; it was unethical not to do so, against the General Medical Council rules and not in the patient’s interests.

“Clinicians must record what they are doing. You can opt out of having that data shared with anyone else,” said Cayton , cautioning, however, that withholding information from other health professionals did not provide for good healthcare.

“The debate gets confused because we are not sufficiently clear about data recording and data sharing,” he added.

“Ministers have said and we have said from the [national] programme and the Department of Health that no one will be denied care on the NHS because they refuse to take part in the NHS Care Record.”