Trials of ‘summary spine record’ to begin in 2006

Summaries of GP records from a small number of practices are to be loaded onto the NHS spine from August 2006 as part of a new evolutionary ‘pilot’, intended to test the basic concepts around shared summary care records.

The strategy, set out in a consultative document published today, indicates a far more gradual approach to the development of the ambitious national system of shared electronic records known as the NHS Care Records Service (NHS CRS), and an attempt to provide a pragmatic response to delays in delivering new electronic record systems in the acute sector.

According to the document ‘A Step on the Journey’, approved by the Connecting for Health (CfH) clinical leads and Service Implementation Board. Development of an initial shared electronic record, combining clinical data from both the acute and primary care, is now not due until 2007 at the earliest.

As a result the only clinical details to be on the spine record initially will be a brief summary record from GP systems, which will be automatically loaded up from the systems of participating practices.

It is hoped that by the end of 2006 some 30-40 practices will be participating in the pilot. Practices that volunteer will have to be using spine compliant GP practice systems and have the quality of data on their systems accredited to standards yet to be finalised, says the consultation document.

Initially the summary record will be extremely simple, typically containing just a handful of diagnostic codes, and some free text entry. Dr Gillian Braunold, joint GP clinical lead with Connecting for Health, told E-Health Insider this would typically be just six codes to start with: major diagnosis, major procedures, current and regular prescriptions, drug allergies, adverse reactions and interactions.

Certain diagnoses will not be loaded up in this summary, including mental health, sexual health and some infections. "If prescription items are specific to these diagnoses, then no prescriptions will be uploaded. There will be a generic warning attached to the summary record indicating that some data may not be included," says the document.

The pilot will make use of the "simpler messaging formats" expected to be available in mid 2006, but will not use any information from hospitals until acute spine messages become available, hopefully by mid-2007. Until hospital messages become available the summary GP record will remain the only clinical component of spine summary record, technically known as the personal spine information service (PSIS).

The consultation document says that the benefit of the approach is that it will make use of data already available rather than waiting for hospital systems to be ready. "There is as yet little sophistication in the recording of electronic records in the secondary care sector. Utilising the data that is held in a summarised form in general Practice so that patients’ data is available for their care wherever they are is a benefit that is possible to deliver quickly."

Dr Braunold described the new approach as a pragmatic step to use what was available to build confidence among clinicians and patients and work through the issues involved.

"By the end of 2006 30-40 practices, running accredited hosted systems, will be uploading summary records. We’re not going to be enabling the whole country to go at once," said Dr Braunold.

Summary GP patient records from the practices involved will be automatically loaded onto the NHS spine, forming the initial PSIS summary record. Eventually the intention is that the spine summary record will be automatically updated every time a patient visits a hospital, receives treatment or receives medication, with earlier versions of the record retained for future audit.

It will be assumed that patients have given their ‘implied consent’ for their details to be loaded onto the spine. At a later date it is envisaged that clinicians will ‘opportunistically’ get the explicit consent for their details to be shared when they next see the patient.

Work on the data quality accreditation is now beginning. "We’re working on an accreditation standard for that now," said Braunold, who added this could be an automatic software tool.

Although adopted as policy by CfH the new policy has yet to be approved by the joint BMA GPC and RCGP IT Committee. Dr Paul Cundy the chair of the joint group told EHI: "It is not signed sealed and delivered, this is a consultative document and no-one should believe the GPC or BMA have approved it yet."

He added though that the emphasis given to the importance of data quality was welcomed. "Data quality is paramount, before you import data onto the spine it must be accurate."

The Department of Health and Connecting for Health is understood to have identified data quality accreditation as a top four priority in its renegotiation of the Quality and Outcomes Framework of the GP contract with the General Practitioners Committee of the BMA.

Dr Braunold said that the pilot launch of the summary spine would also be tied to local public communication work, explaining the benefits of the move: "The launch will be accompanied by a public information campaign for all patients in areas covered by the practices involved."

She said of the pilot: "It’s piloting the technology and enabling people to test out the model and access controls and build confidence in the vision. This approach enables us to test what is possible and build the summary record to build confidence."

Dr Braunold described the new approach as a pragmatic way of working with what would be available, and said that there had been a delay in putting hospital services on the spine. "The other stuff won’t be ready for another year, with the complex messaging envisaged for 2007. None of the hospital messages will go to the spine initially."

What is not clear at this stage is the expected clinical utility of the record, or precisely how patients will initially benefit from a summary of their GP record being held on the spine and made available to a range of authorised clinicians. CfH says the summary spine record will be used to treat patients in immediate care settings such as walk in centres, out-of-hours care, and be used in emergency care settings.

According to Ewan Davis, chairman of the BCS Primary Health Care Specialist Group, the clinical value of the initial summary record at least is likely to be limited. "Even if it is successful it will be at best only moderately useful as it will only apply to a tiny proportion of encounters that occur between GPs and patients every day."

Dr Braunold said she was absolutely certain patients would benefit by patient information being linked together and made available to clinicians. "If patients don’t gain benefit we will review it."