Local trust data overwritten by Choose and Book

E-Health Insider has learned that some hospitals linked to the national Choose and Book appointment booking system are having some local patient record details unexpectedly over-written each time they receive an electronic referral from the NHS spine.

As a result, the affected hospitals have to manually re-enter deleted patient details — such as the patient’s telephone number, name of their GP and next of kin — after every referral.

The national Choose and Book system, uses the NHS spine’s Personal Demographic System (PDS), and is set to over-write some local data on hospitals patient administration system with the data from the PDS – even though this can often be incomplete or inaccurate, and outside the direct control of individual hospitals.

NHS staff who have spoken to E-Health Insider have expressed concerns about the impact on local data quality, the potential risks to patient safety and financial consequences to trusts on billing and contracts with SHAs and PCTs.

Data affected includes patient’s telephone number, contact details for next of kin and even the name of their GP. One trust has found that every time the national PDS fails to recognise the GP held on patient’s PAS record it over-writes the field with a null entry – removing the details of who the patient’s GP is.

E-Health Insider has spoken to two NHS hospital trusts in the Eastern Cluster of the NHS National Programme for IT — using different iSoft patient administration systems — who have had to introduce cumbersome work-arounds to prevent local data quality being undermined.

Addenbrooke’s, one of the leading teaching trusts in the country, has been an enthusiastic early adopter of Choose and Book with the system now live in 39 specialities. But because of the problems with local data being automatically replaced with data from the spine the trust now relies on paper as never before.

Bill Wilson, Assistant Manager of Choose and Book at Addenbrooke’s is an advocate of e-booking and the benefits it will deliver benefits to patients, but he admitted to frustrations with the way the current system works.

"The way the Choose and Book process works is that existing data will be over-written as part of the Choose and Book process," said Wilson. "If there is a discrepancy it will make a duplicate entry."

With the accuracy of PAS data in question following an electronic referral admin staff at Addenbrookes are using the paper referral letter — one of the pieces of paperwork Choose and Book is meant to eliminate — as the ‘gold standard’. And re-entering data where required.

"We have to do that with every referral, because things like telephone number don’t come across," said Wilson. He said it was not something they’d anticipated having to do.

Another key data field affected is which health community the patient is a resident in, "which impacts the billing side of things", said Wilson. He told EHI that the problems would hopefully be solved in the next Choose and Book release from iSoft for the trust’s iExpress PAS system.

At another NHS hospital trust in the region, a member of staff who asked not to be named, told EHI of the problems they face following the upgrade of their local iSoft Clinicom PAS to accept Choose and Book referrals. To overcome the problem of data being overwritten staff must take an overnight back-up of PAS data to use as their reference to re-enter data — before electronic referrals come through the next day and overwrite patient data fields.

Dr Paul Cundy chair of the RCGP/GPC IT Committee told EHI that the problem with the PDS over-writing local data on GP systems had also occurred in the earliest version of Choose and Book, but a facility had since been introduced to enable primary care staff to accept or reject such changes.

Connecting for Health said in a statement that it was "aware that some early upgrades of existing PAS systems did not provide the facility to carry out necessary integrity checking between local and national data".

The agency said that it was best practice for GPs, or their practice staff, to check the integrity of a patient’s current address "and make any updates required directly onto PDS, as this will be the data that the PAS uses".

CfH told EHI that it was aware of reported problems from sites using iSoft’s Clinicom system: "We understand that some Clinicom sites have reported this, however we can’t comment on existing systems outside of NHS Connecting for Health contracts, such as Clinicom."

Asked whether it understood that trusts affected by local patient data being overwritten had concerns about patient safety, CfH responded: "yes we do, however, by GPs or their practice staff following best practice in checking patients’ addresses at the point of care, and providing the necessary functionality to carry out integrity checking of local and national data, any clinical safety risk is mitigated."