We would like to correct some inaccuracies in reply to the essay by Dr Gordon Baird in the Back Pages of the February edition of the BJGP in which he made comments about the Emergency Care Summary (ECS) in Scotland.1
As Dr Baird says in his article, information should only be disclosed in the interest of the patient. That is the sole aim of the Emergency Care Summary. It contains clinical information on current medication, allergies, and any adverse reactions to medications that are recorded on the GP clinical system. Patients can opt out of having their ECS information uploaded from their GP record but, even when it is available, the information can only be accessed with the explicit consent of the patient for that episode of care. This means that the clinician has to obtain consent from the patient before accessing their ECS and this facility is only available for clinicians working in NHS 24, out-of-hours organisations, A&E departments, or other acute receiving units. This consent model has been approved by the BMA, the Scottish Government, the GMC, and EU lawyers.
Dr Baird states that the information in ECS may not be accurate but, by limiting the clinical content to prescriptions that have been prescribed electronically and to adverse reactions that have been recorded, and by updating the uploaded ECS twice daily, the accuracy of the record is high and the likelihood of including erroneous data minimal. In addition, Scottish practices have been paid through an enhanced service in 2007/8 to check the ECS data systematically for their patients.
Dr Baird unfortunately muddles the different consent models and guidance for the Connecting for Health Summary Care Record in England and the Emergency Care Summary in Scotland. This is confusing for readers as the two projects differ significantly in detail of both content and regarding future plans.
Dr Baird states that the audit trail can be over-ridden by the ECS user setting ‘no notification to GP’. This facility is used to support patient privacy, not to over-write any audit trail. The whole process, including any accesses from end to end, is regularly audited to a very high standard, for example, failed log ins, excess log-on durations, and user profiling. All of this data are available on request via each practice manager.
Dr Baird asks who is going to gain most from this information sharing. In the 2 years since the ECS has been in use across Scotland, evaluation in NHS 24 and A&E has shown that it has been found to be of strong clinical benefit by the clinicians who are entitled to use it. NHS 24 clinicians have been able to deal with queries about medication and dosage without the need to refer the patient for a face-to-face consultation. ECS has been particularly valuable for clinicians dealing with emergency admissions on public holidays or weekends when there is no access to GP surgeries, and for the ‘hospital at night’ teams.
Clinicians report that it reduces phone calls to GPs, and that a written list is safer than a receptionist reading a list of medication from a screen. Additionally, clinical pharmacists in acute receiving units for unscheduled care can now take a drug history verified by ECS with consent from patients. The pharmacists even report that some GP practices complain if a phone call is made to check the medication as the GP practices now feel that ECS makes this unnecessary. The outcome of our evaluation is that patient safety is considerably improved by the quality of the information and the amount of time saved.
In summary, in a quote from a clinician: ‘this has raised the bar for quality and safety for patients’, which reminds us that that is the ultimate goal of the ECS.
- © British Journal of General Practice, 2008.