Connecting for Health is planning for every patient in England to have a complete Summary Care Record by the end of 2008.
Guidance prepared by CfH for strategic health authorities makes it clear that the Clinical Summary Record will be implemented in two phases. Phase one, due to begin by Easter, will consist of an early adopter implementation of the GP part of the summary care record (SCR). Phase two, to be complete by the end of 2008, will use the findings of the early adopter phase for a full roll-out across England of the SCR by the end of 2008.
The guidance sets out in detail how the implied consent model for the early adopter sites will work and patients’ options for withholding consent. If patients do not opt-out an initial text based summary of their medications, allergies and adverse reactions will be uploaded to the spine. If patients choose to dissent from data sharing, a patient’s summary record will be restricted to the authoring GP only.
After the upload patients have two options. They can choose to remove some items from their summary record, known as ‘tailoring’ and done by the clinician, or they can send a blank summary update which includes demographic information only and a message that the patient has chosen not to have a summary record.
Patients can consent to sharing their summary, dissent from sharing but still have the information uploaded in case they change their minds or dissent from sharing and have no summary uploaded.
The initial summary will be replaced with an update summary, which will be triggered by a consultation and contain coded and possibly more comprehensive information. This will allow the GP and patient to validate the summary and choose from further options for updating the summary. After that a summary record will be triggered by a significant event such as a test result entered from a discharge letter.
The guidance adds: “The early adopter programme will evaluate the process by which patients and GPs can identify and agree which elements of the clinical record should be uploaded to the spine.”
The guidance says patients will be fully informed about the SCR through a public information programme and that NHS Direct will provide a helpline which will be the first point of contact for patients to ask more questions about the SCR.
The guidance says that, in order for the summary record to be of use to clinicians in unscheduled care, deployment of the Clinical Spine Application will be held back until a critical mass of 60% of patients in the health community has a summary record.
The guidance sets out a range of activities primary care trusts and GP practices will need to complete to implement the SCR including undergoing data accreditation, upgrading GP systems to be SCR compliant, training in the new functionality and engaging with patients.
The document states that the first wave of the early adopter programme will begin in the first quarter of 2007/8 with a small number of practices in one PCT, followed by roll out to more practices in that PCT and the trial of the programme in a second PCT. In the last two quarters of the year second wave practices will go live with the SCR. Access to the SCR via Healthspace will be available from May or June 2007.
The guidance adds that the rollout of the SCR is dependent on the release of 2006-B Spine release, due 26 March, and GP compliant systems. The early adopter sites are to be limited to 2.5m patients.
The second half of the 26 page guidance document focuses on work hospital trusts will need to do to prepare for the SCR including upgrading all their Phase 1 Release 1 (P1R1) systems by the end of December 2008. Trusts that use an existing system will also be required to upgrade to the full NHS Care Records Service including cleansing their Master Patient Index to meet the mandatory use of the NHS number and issue smartcards to all staff.
The guidance also covers plans for the NHAIS (Exeter) system to use the spine as its source of demographic data.
Link
Implementing the Summary Care Record