INFORMATION FOR HEALTH
The visionary American writer William Gibson is credited with saying that ‘The future is here — it’s just not evenly distributed’. This is particularly true for medical information systems, and nowhere truer than in the NHS. Indeed, in his book God Bless the NHS, reviewed in this issue, Roger Taylor argues, perhaps not all that convincingly, that the very future of the service lies in the quality of collection and analysis of outcome data. In a series of thought-provoking articles, contributors this month examine a range of topics related to information management and health care.
Wallace and colleagues draw our attention to the importance of the CPRD (Clinical Practice Research Datalink) as a research tool. This large observational database, launched last year and funded jointly by the NHS National Institute for Health Research and the Medicines and Healthcare products Regulatory Agency, has enormous potential to deliver significant research outputs and healthcare and public health benefits. They emphasise that GPs need to engage with the service to maximise its benefits, and they also spell out some key principles, developed by the Wellcome Trust, and endorsed by the BMA and the RCGP which apply across many aspects of patients’ data management in the health service. These are that patient confidentiality is safeguarded, GPs should play the role of patients’ advocates and public awareness and understanding of the use of medical records in research should be improved. The last sentiment is echoed by Stephen Humphreys, who discusses some of the ethical concerns around the use of patient data for research, and encourages a ‘proper public discussion’ about it.
Should patients have access to their medical records? Brian Fisher is a strong advocate of patient access, which he believes will have a range of benefits, including the possibility of increasing capacity in primary care, but Richard Vautrey sounds a more cautious note. He is not convinced that large numbers of patients want access to their records and is concerned that the potential impact on care and the risk to patients’ trust in their GPs may, at present, outweigh the benefits.
Quality measurement in general practice will always remain high on the policy and research agenda, and in their editorial Kordowicz and Ashworth look beyond the metrics and propose that as well as quantitative, ‘stretch’ targets for the direct measurement of excellence, consideration should be given to ways of capturing more qualitative aspects of care in general practice, which may better reward practices who ‘go the extra mile’. Their ideas will, I believe, resonate with many clinicians, recognising the limitations of the current system. They will certainly, I imagine, resonate with Kevork Hopayian, whose provocative contribution suggests that QOF exception reporting could be regarded as a quality marker in itself. He comments that ‘warranted exceptions are a consequence of patient-centred care, an indication of evidence-based, not driven medicine, a mark of quality practice. I doubt very much that they would ever attract their own QOF points’.
Last month we announced our new open access publishing arrangements and it seems that some misunderstandings may have arisen about them. For clarity, we only expect article publishing fees to be paid from research grants in which they are prespecified, and the costs of publishing research outputs is included in the grant. There is no expectation of departments or individuals having to find these charges themselves, unless they wish to make an article immediately accessible, through open access. Potential authors and contributors should not be deterred by the open access arrangements, which are not a barrier to submission. Perhaps most importantly, open access charges do not ‘buy’ publication of lower quality articles: the peer review arrangements remain as rigorous as ever. As always, please contact us if you have any questions or concerns about this.
Last month’s cover design puzzled a few readers. It was, of course, a colour version of a Rorschach inkblot, a device used to assess personality, devised by the Swiss Freudian psychiatrist Hermann Rorschach in the 1920s. The viewer’s personality is revealed by their interpretation of the blot. What did you see?
