SCR evaluation finds few benefits
- 17 June 2010
The final report of a three year evaluation of the Summary Care Record has found that it has yet to deliver significant benefits.
Researchers from University College London also found few benefits from HealthSpace, the online portal that enables patients to log health information and view their SCR.
Only one in 1,000 patients invited to open an advanced account to access their SCR had done so. Most people using HealthSpace found the functionality limited and perceived few – if any – benefits from it.
Professor Trisha Greenhalgh, lead author of the 234 page report, ‘The Devil’s in the Detail’, said she hoped the government would look carefully at the researchers’ findings before making decisions about the future of the SCR and HealthSpace.
Professor Greenhalgh, who has recently moved to Queen Mary University of London, said: “This research shows that the significant benefits anticipated for these programmes have, by and large, yet to be realised – and that they may be achieved only at high cost and enormous effort.
“When we did find [benefits], they were subtle, hard to articulate and difficult to isolate. It serves to demonstrate the wider dilemma of national databases: that scaling things up doesn’t necessarily make them more efficient or effective.”
The Department of Health said it welcomed the report and would consider its findings. It reiterated the message contained a letter to the BMA from health minister Simon Burns last week, pledging a review of how patients are informed about SCRs and the content of the record.
The three year, one million pound evaluation found a number of ‘wicked problems’ delaying progress with the SCR and HealthSpace.
These include the difficulty of defining a minimal dataset of key data the SCR should include, the task of ensuring that GP data is complete and accurate, the need to gain informed consent from 50m people – many of whom appear to throw information letters away unread – and the technical and operational challenges of uploading data to the SCR.
Where SCRs were in place, the researchers found evidence of improved quality in some consultations and evidence that the SCR was useful for patients unable to communicate or advocate for themselves.
However, they found no direct evidence of safer care and no impact on consultation length or the number of referrals made. The researchers said the impact of the SCR on patient satisfaction was impossible to assess.
On HealthSpace, they found no evidence of improved personalisation of care, no evidence of increased patient empowerment or ability to manage their long term condition, no evidence of improved health literacy and no impact on data quality or reductions in NHS costs.
The researchers said the most striking characteristic of the SCR and HealthSpace programmes was their scale and complexity.
They said successful introduction of the SCR required collaboration between stakeholders from different worlds with different values, priorities and ways of working and that there were still significant barriers to the widespread use and adoption of such records.
However, they also said greatest progress was made when key stakeholders came together to try to understand each other, even when a consensus was not reached.
Dr Laurence Buckman, chairman of the BMA’s GPs Committee, said the BMA did not oppose shared electronic records in principle but that it had long voiced concerns about the way the SCR programme had been implemented.
He added: “It should not have been rolled out ahead of the findings of this evaluation – which uncovers some very serious problems – being published. We are pleased that the programme is now to be reviewed.
"The BMA is very happy to engage with the government to try to find a way forward that has the confidence of both patients and professionals.”
Opinion and analysis: Read more about the SCR evaluation in Fiona Barr’s opinion and analysis.
