CfH says SCR audit trails ‘clunky’

Connecting for Health has acknowledged the audit trail facility in the first Summary Care Record pilots ‘has been clunky’, after minutes from the board of Bolton PCT expressed concerns over the functionality.

Problems are reported with the time required to review audit trail alerts – created by the SCR system. In official minutes, a member of Bolton PCT’s SCR board branded the amount of time required to use the audit trail functionality as ‘ridiculous’. 

The ability to track and review who has viewed a patient’s summary record is one of the key security features of the SCR.

According to papers released by Bolton PCT under the Freedom of Information Act to Computer Weekly magazine, the PCT, one of the SCR early adopter sites, had difficulties keeping up with alerts on its audit trails.

The magazine reports the board papers saying: “[Name unknown] is having to put a lot of time into this task and, at the moment, we do not have all that many alerts coming in as the system is not being used to its full potential yet. [Name unknown] felt that the audit trail is ridiculous and asked how they hope to be able to manage it nationally.

“[Name unknown] informed the group that NHS Connecting for Health had envisaged that this task would take one day per week for each primary care trust which [name unknown] pointed out is still a great deal of time. At the moment it is taking [name unknown] around an hour to look at 10 alerts.”

CfH’s clinical director of the SCR, Dr Gillian Braunold, told EHI Primary Care that the audit trail facility was not yet working in the way that she hoped it would.

“It has been clunky and not quite as right as I’d like to see it. But for the last four weeks it has been working properly and they are getting information promptly. I don’t think the process is as good as it could be, but Bolton and CfH are working to address this and it is fundamental that privacy officers have the tools they need to do their job properly,” she said.

The system launched in September 2007 and has issued 270,000 letters to patients, with 0.9% of the patients opting out of having their SCR uploaded. Some 94,000 records have been created on the Spine.

As well as the audit trails, other issues during the pilot reported by the magazine include almost 3% of leaflets on the SCR being returned because the recipients had changed address.

The board paper states: “There is a risk that patients who have moved address may get a Summary Care Record when they would have chosen not to have one… if a search is performed for any patient on CSA – the clinical spine application which allows NHS staff controlled access to the national Care Records Service – the software will give consent status as “Implied Consent”. For any patient who [is] not yet part of SCR early adopters, this is incorrect, as implied consent implies they have been informed about SCR.”

Braunold said: “The 3% figure was not unexpected. We had planned for this and we have asked all GP system suppliers to have a code for any patient whose mail is returned to the GP practice. We must stress that no SCR will be set up for any patient whose mail is returned to us.”

GP systems in the region also reportedly encountered problems with the SCR system. 

“GP systems continue to be affected by performance issues, and the source of these performance problems is still to be totally identified and resolved… Although an additional eight practices were identified to go live before Christmas, only one was uploaded… due to issues with their data quality and paper light status”.

Teenage records and duplicate records were also considered by the board, as well as out-of-hours access with four unscheduled care settings viewing the summary care records.

“Records for under 16s may be uploaded when they have not been informed of SCR … There are many duplicate records within the Adastra system run by Bolton Out of Hours. If OOH continue to generate duplicate records there is a risk that Summary Care Records usage may be impacted as there will not be easy access to NHS number, if original record is not found.”

Braunold said that the early adopter sites were now working on these problems, and stressed: “These issues are not unexpected, especially in the implementation of an ongoing process, it will inevitably take quite a while to get things as spick and span as we would like.”

The board paper follows EHI Primary Care’s report earlier this month, where Connecting for Health defended the decision to allow healthcare assistants to access Summary Care Records in accident and emergency departments.

A Bolton PCT spokesperson was unable to comment on the board paper at the time of publication.