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
| 
