Scotland extends use of ECS

Scottish health boards and GPs have agreed that the Emergency Care Summary can be used in scheduled care to support medicines reconciliation, after a pilot showed clear clinical benefits.

The new access arrangements are being rolled out in phases, starting with five boards: Grampian, Highland, Forth Valley, Tayside and Lanarkshire.

The ECS is a summary of patient information extracted from GP patient records and includes demographics, allergies and medication history.

Access to the ECS has previously been only in unscheduled care settings, such as A&E departments and out-of-hours services.

However, extending access to the summary is a key aim of the eHealth Strategy for NHS Scotland.

NHS Lanarkshire carried out a pilot on behalf of NHS Scotland, allowing about 30 clinicians – mostly pharmacists – access to the ECS.

The pilot focused on four scheduled clinical areas; cancer services, elderly day care, surgical pre-assessment and elective surgery.

The intention was to assess the benefit of getting up-to-date medicines information from the ECS, as the medicines listed in referral letters are sometimes out of date by the time a patient is seen at hospital.

The pilot report says a study of 405 patients showed the ECS was accessed in 75% of cases.

One hundred records were not accessed, either because there were other sources of data readily available to the clinician at the time (51%); the patient was not on any medications (20%); or there was a ‘patient opted out’ flag on the GP system (20%).

Results show that in 22% of accesses, the ECS contained information that was not available from any other source.

Clinicians reported that in their opinion, access to this information prevented harm to 23 patients and that had this information not been available, the patients would have required monitoring or intervention.

In seven patients the additional information in the summary resulted in a change to the clinical management plan.

The report said that extrapolating the use of ECS in two of the study areas – elderly care and pre-assessment – this would have averted harm in 72 and 448 patients respectively in one year.

Pilot programme manager Sean Brennan said patients were always asked for consent to view their ECS. The clinician then had to complete an audit form indicating whether the access was clinically beneficial.

The Lanarkshire clinicians that were part of the trial are continuing to access the ECS with permission from their patients, and the health board is looking at a phased implementation into other areas.

Brennan said boards are taking a “softly softly” approach as the ECS’s primary purpose was for emergency care and appropriate safe guards need to be in place before its use is expanded.

“You can’t just say across Scotland, ‘this is fine, go ahead it works great’, you need strict auditing controls,” he explained.