SCR evaluation data shows added value

Data from the evaluation of the Summary Care Record shows the SCR sometimes adds value in out-of-hours consultations but so far has made a limited contribution in secondary care, according to a report presented to Connecting for Health.

The SCR evaluation team from University College, London, have collected data from 108 consecutive medical encounters where they examined use of the SCR and its added value, both in the view of the UCL team and the clinician using the record.

Prof Trisha Greenhalgh, who leads the independent evaluation team, told EHI Primary Care that it was impossible to draw conclusions from the data at this stage with much more data to be collected and analysed before the final report in published in May 2010.

She added: “These are not findings it is just data and the final report will not say either the SCR is of no use or it’s the best thing since sliced bread. It will be a nuanced report on what is a very complex area.”

The evaluation team presented its provisional conclusions from the data so far to an extraordinary meeting of the Summary Care Record Advisory Group at the end of June and minutes of the meeting have been published by CfH this week.

Dr Gillian Braunold, clinical lead for the SCR project, said the SCRAG was clear that there was a big difference between use of the summary record in A&E at the moment and in out-of-hours centres where the SCR was integrated into the out-of-hours software.

She added: “We had a lot of discussion with Prof Greenhalgh on the emerging benefits in primary care where there is increasing evidence that the SCR is providing benefits in terms of clinician confidence in decision making and changes in therapeutic decisions which echoes our own findings.”

Dr Braunold said the SCR team’s own findings were also that two other settings currently experiencing the most benefits were hospital pharmacists working in medical assessment units and district nurses.

The evaluation team said they had so far followed 108 medical encounters taking place in a variety of settings including GP out-of-hours consultations (including base visits and telephone consultations). GP home visits, nurse telephone consultations and nurse walk-in centre consultations, minor and major cases in accident and emergency and a medical admissions unit.

The 108 encounters produced a 20,000 word qualitative data set and a quantitative dataset but the team said the sample size was not yet large enough to share the quantitative data.

Its provisional conclusions about the use of the SCR for out of hours consultations were that the SCR “sometimes add value”, especially in complex clinical psychological and social cases.

The team said that the SCR was now potentially accessible in out of hours consultation following the introduction of the integrated Adastra functionality but that in many cases it was not available or accessible.

One of the main reasons for unavailability is the percentage of patients for whom a record as been uploaded. In NHS Bolton, which along with NHS Bury has been the focus of the SCR evaluation, approximately 35% of patients had an SCR by the end of May although the PCT hopes to roll-out the SCR to cover 60-70% of patients by the end of the year.

Figures released to EHI primary Care by NHS Bolton in May showed the SCR was used in one in four consultations when it was available but access to the record in the accident and emergency department at Bolton were lower which is partly attributed to the current lack of integration between the SCR and IT systems used in A&E departments as well as the percentage of patients with records.

The SCR Advisory Group said iSoft Lorenzo, Cerner Millenium and Ascribe were developing their systems to integrate with the SCR which would increase record accesses in secondary care settings. Dr Braunold said it would be February or March next year before the first of those integrated applications went live

The SCR evaluation team told the SCR Advisory Group that its work so far in A&E led it to “tentatively suggest” a series of key conclusions

These were that the A&E department was a complex place where the logistics of individual log-ons to computer terminals and gaining consent to view the SCR were much more challenging than in primary care.

It said information needed to manage unconscious and other ‘major’ patients was also predominantly real-time, rapidly changing data and that the SCR as ‘historical’ and relatively static document seemed to make a “limited contribution” in most actively sick patients.

The SCRAG said that it was too early in the project to be able to draw conclusions about the benefits associated with the use of the SCR application in secondary care.

The evaluation team will continue to monitor A&E settings and also look at additional care settings including medical assessment centre use by hospital pharmacies, surgical outpatients and day surgery, ambulance unit use for level three calls and mental assessment units.

The initial report on the SCR evaluation was published in May 2008 and recommended a review of the implied consent model for the SCR which led to the adoption of consent to view for the SCR.