Patient told no electronic record, no care

A North London Mental health trust has said that any patients who refuse to have their data entered onto electronic patient records will not be able to receive treatment.

Barnet, Enfield and Haringey Mental Health Trust told a patient who asked not to have an electronic patient record that it would be impossible to provide care without using an electronic record.

The trust says that its RiO EPR system has entirely replaced paper patient records, making it impossible to provide care without using the system apart from in the most exceptional circumstances.

A trust spokesperson confirmed that the director of strategy and performance had written to a patient explaining that the trust had a legal requirement to maintain local patient records, and now only did this electronically.

The upshot, the letter explained, was no electronic record, no care: “If a service-user refuses to have the necessary information recorded in the electronic care record then, due to the above legal requirement and duty of care the trust would be unable to provide treatment.”

The trust told EHI, “CSE Servelec’s RiO is the care records system we now use. It is part of the national programme for IT, but currently we do not share patient’s demographic details across the NHS through use of the ‘Spine’ provided by BT.”

A spokesperson said that the concerns most patients had related to fears about their record being held on the planned national care records system, rather than the local RiO system.

“People confuse the national record system being developed by NHS Connecting for Health with RiO the system we now use. We don’t keep paper records anymore.”

The spokesperson said when the difference between the two was explained patients were almost always happy to have a local electronic record. They acknowledged though that the eventual plan was to connect the local system to the national care records system.

The spokesperson said that under exceptional circumstances the trust could anonymise a patient’s electronic record, but would not offer them the option of paper records.

“In exceptional circumstances where a patient does not wish their name to be linked to a medical record on RiO, if the clinical team agrees, information about their treatment can be maintained in an anonymised manner on our electronic system.”

If a patient did request to stop having their details recorded electronically, or anonymised, the trust would seek to convince them of the benefits, said the spokesperson. “We’d seek to persuade them that we have to use RiO to provide their care.”

The trust made clear that a decision to anonymise would not be automatic in response to a request by a patient, but be based on a determination made by the “respective Assistant Director and Associate Medical Director of the service the staff member is referred to” about the individual and circumstances.

“The decision to offer anonymisation will be based on an assessment of the individual’s circumstances, clinical and social. If a person’s fame or celebrity was likely to adversely impact on their treatment should it become known; then we would agree to anonymisation. However, no ‘paper based’ alternative to the electronic record is available.”

The trust concluded its statement by stressing that it is a legal obligation to keep a legal record of treatment and all patient records at the trust are now electronic.

“If this was explained to a patient who has ‘capacity’, and they understood, but still insisted that no electronic record could be made of their treatment, while we would be willing to treat them, it would only be under conditions of appropriate clinical governance which includes keeping a safe and secure electronic record of their care. To decline this would be to decline treatment.”