Select Committee on Health Written Evidence


Evidence submitted by Help the Aged (EPR 63)

EXECUTIVE SUMMARY

  1.  The electronic patient record should include the single assessment process assessment and care plan and should be compatible with existing electronic SAP systems.

  2.  Information on the assessment of met and unmet need and whether outcomes have been met for people who use health and social care services should be capable of being collated and anonymised from the electronic record to inform commissioning.

  3.  Medication histories should be recorded and shared on the electronic record as communication is often poor across primary and secondary care in providing co-ordinated medicines management. This has serious consequences for people who are on four or more medications, most of these people are over 60 years old.

INTRODUCTION

  4.  Help the Aged welcomes the opportunity to comment on the electronic patient record as this provides an opportunity for sharing information about a person's assessed needs and wishes and the care plan that has been developed with them.

  5.  The national service framework for older people (NSF) introduced the use of a single assessment process (SAP) so that information about an older person's needs, wishes and aspirations could be shared across health and social care to avoid duplication of assessment and to improve communication in delivering a seamless service.

  6.  Successful implementation of SAP has been dependent upon health and social care staff having access to electronic records that can be shared across agencies. This challenge has resulted in slow progress with implementation of SAP across health and social care communities. The electronic patient record may support implementation, provided lessons are learnt from the implementation of SAP and existing SAP systems are compatible with the electronic patient record.

  7.  The sharing of information on medication is another important issue as older people are often prescribed more than four drugs at one time and the medical history on medication is not always shared successfully across primary and secondary care. Failure to manage medicines effectively and carry out regular reviews with patients on more than four medications can lead to serious complications.

What patient information will be held on the new local and national electronic record systems, including whether patients may prevent their personal data being placed on systems?

  8.  Help the Aged are not aware of what information will be held on the new local and national electronic record systems. However, we strongly recommend that this includes the SAP assessment and resulting care plan and information on medicines prescribed.

  9.  Patients should be asked to agree for personal information to be recorded and shared and if they have any objections to being asked which specific information they would not want to share. Patients should have a copy of the SAP assessment and care plan as they own this information.

Who will have access to locally and nationally held information and under what circumstances?

  10.  At a local level all professional and care staff providing health and social care services to an individual should have access to their electronic patient record. This includes staff working in the primary care trust (PCT), acute hospital trust, mental health trust and social services.

  11.  At a PCT level information should be collated and anonymised to inform commissioning and decommissioning of services. The development of commissioning plans based on individual assessments of need through the SAP was outlined in the white paper "Our health, our care, our say". However, this has not been achieved in England to date due to the quality of information collected and the inadequacy of the existing electronic systems. The electronic patient record system should be capable of collecting information on individual met and unmet needs, measuring outcomes for people who use services. Commissioning managers and heads of service would need access to this anonymised information to develop a commissioning strategy and make commissioning decisions for the local population

  12.  The medication history of individuals should be shared at a local level across primary and secondary care and with social care. At a PCT, regional and national level this information could be used for the purposes of audit, provided that it was first anonymised.

Whether patient confidentiality can be adequately protected?

  13.  All professional and care staff should be bound by their code of practice and their job description to respect patient confidentiality, regardless of how the information is collected and stored. The sharing of information across professional groups and agencies is less clear and this has caused problems in the past with the implementation of an electronic SAP system as professionals are uncomfortable with sharing information. Clear guidelines are required on what can be shared and for what purpose if electronic records are to result in the effective sharing of information to improve the quality of care.

How data held on the new systems can and should be used for purposes other than delivery of care e.g. clinical research?

  14.  The data held on the new systems can provide valuable information for:

    —  monitoring the quality of contracts

    —  carrying out local and national audits of services

  15.   If information is collated and used in this way it should first be anonymised

RECOMMENDATIONS FOR ACTION

  16.  The electronic patient record should include the single assessment process assessment and care plan

  17.  The electronic patient record should be compatible with the existing electronic SAP systems

  18.  The electronic patient record should include medication history

  19.  Guidelines should be produced for frontline staff on sharing information

  20.  Data from the electronic patient record should be collated and anonymised to inform commissioning

  21.  Data from the electronic patient record should be anonymised and collated for local, regional and national audit

Help the Aged

March 2007





 
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