A primary care trust has recommended that GP practices do not transfer patient records using a CD citing concerns over the IT literacy of practices and the security of patient information.

The CD transfer system, developed in Hertfordshire and backed by NHS Connecting for Health as an interim measure, enables practices to send a CD-ROM holding the entire patient record including attachments. The CD is sent inside the Lloyd George envelope, in place of the paper records, and is designed to save on vast paper printouts and degradation of rescanned images before the introduction of CfH’s GP2GP record transfer system becomes widespread.

However Hampshire PCT has contacted practices to tell them that it does not recommend the transfer of data using CD and that its preference is to pursue the strategic option of GP2GP direct electronic transfer system.

A spokesperson told EHI Primary Care: “Hampshire PCT is aware that a number of PCTs in England are allowing GPs to use compact discs to transfer patient notes and records. Our view is that although this would appear to be an efficient means of sharing data, there are still significant concerns about transferring data onto

CD, for example the security of the information, can the information be readily accessed and downloaded or opened by the receiving practice, can scanned documents be read properly, verification of the completeness of the data and delay in the transfer of information if the receiving practice have to request the hardcopy of the record.”

Devon PCT also says it has concerns about use of CDs and practices from other parts of the country have reported that CDs sent to Devon practices have been returned by its Patient and Practitioner Services Agency.

A spokesperson said: “In Devon we have raised concerns at national level about the problems associated with using CDs to store and send patient information. This includes issues about varying levels of computer literacy among GP practice staff which could mean data is at risk of corruption.”

Roz Foad, IM & T service manager for West Hertfordshire PCT, developed the project last year in conjunction with local GPs to help practices overcome the time and patient safety issues involved in the current paper-based transfer of medical records. Since then the project has been taken up by GP computer supplier EMIS which has enabled all its EMIS LV users to transfer records between practices using a CD but can also be used by all other system users, following the protocol and system specific instructions developed in Hertfordshire. Documents are produced in Word, TIF and RTF format which can be read on any PC. Practices not wishing to use the CD can ring the sending practice to ask for the paper notes to be forwarded. CDs are transferred using the same system used for paper notes.

Foad told EHI Primary Care that she did not understand PCTs’ concerns. She said: “GP2GP across the spine still needs the back up process on paper or CD to continue until we have it confirmed otherwise. We are part of the GP2GP pilot and using CD back-up with CfH’s blessing. It will be several years before every practice in the country is able to transfer across the spine, this is an interim measure until then.”

Foad said practices must be approved by their PCT for CD transfer of records and that practices are visited by PCT staff and have to prove that they are following the protocol in producing the CDs and forwarding them to the records agency. No practice would be considered if it did not have paperlight status.

She added: “There is no possible risk of data corruption at any stage of the process. CDs are virus checked before leaving the practice and again before being read on the receiving practice, which would be basic common sense for any CD usage. The CD and full instructions on how to import the record is sent in the envelope to the receiving practice.”

Dr Paul Cundy, co-chair of the Joint IT Committee of the British Medical Association and Royal College of General Practitioners, said it was not within the authority of PPSAs or PCT IT departments to withhold consent from practices.

He told EHI Primary Care: “A practice has to get written agreement from a PCT to transfer records in an electronic format but that is the PCT board, not the PPSA or the IT department, so practices who have been refused should appeal to the chairman or chief executive of the board.”

Dr Cundy said CDs were a useful interim measure but he said he hoped the need to transfer a paper copy alongside the electronic GP2GP transfer would end before the end of 2007.

He added: “The rate of progress being made with GP2GP means we should be at the stage where we don’t need paper any more before the end of this year.”

Even if paper back-up are no longer needed it is highly unlikely, however, that GP2GP will be available to all practices by the end of 2007. EHI Primary Care understands that CfH’s own target is for 3000 practices to be using the system by the end of 2007/8, TPP users will not be able to take part in the project at this stage because of coding differences and other smaller suppliers have still to sign up for GP2GP. The current status of the project is that testing between same system transfers, EMIS to EMIS and INPS to INPS, has taken place, transfers between those two systems are about to begin testing and iSoft users are due to start testing the system later this year.

Hills Goldsmith, deputy practice manager at Litchdon Medical Centre, Barnstaple, Devon, said the stance being taken by Devon PCT was disappointing.

She told EHI Primary Care: “It’s frustrating and I don’t fully understand why they have a problem with it because when we tried it before we didn’t have a problem with it at all. We had one record that was 13 envelopes long and to print all that out is a waste of our paper and time.”

In Sunderland PCT IT clinical lead Dr Angus Goudie said he thought the PCT would approve practices to use CDs, following clarification of one or two information governance issues.

Dr Goudie said: “I think it’s a very good idea. It’s very quick and easy to do and saves a vast amount of printing stuff out on paper. Practices on the receiving end are given the option to ask for a paper copy if they want to or those who want to can upload it straight into their system.”

Hampshire PCT has the support of the local medical committee for its decision not to recommend use of CDS. Dr Christine Dewsbury, medical director of Wessex LMCs, She told EHI Primary Care: “It seems to be trying to reach a fudge which is not considered to be worthwhile at the moment when GP2GP is going to be up and running very soon.”

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