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Patients to gain access to new at-a-glance electronic healthcare records

New drive to put the patient at the centre of the National Health Service

Over the next four years, every adult will be able to access their own at-a-glance electronic healthcare record, UK Health Secretary Alan Milburn has announced.

The initiative, to help redesign the NHS around the needs of patients, is the centrepiece of a rolling programme of investment worth £700m in the next three years to overhaul NHS information technology under The NHS Plan.

The EHR will hold summarised key data about patients, such as name, address, NHS number, registered GP and contact details, previous treatments, ongoing conditions, current medication, allergies and the date of any next appointments. The EHR will be securely protected, created with patient consent, with individual changes made only by authorised staff.

As the initiative is rolled out, up to five million people are expected to have their own lifelong electronic healthcare record (EHR) by 2003, rising to around 25m by 2004. By March 2005, every person in the country will have their own record.

Pilot studies are already underway to find the best way of allowing patients to access their EHR. Possible options include online access via NHS Direct and smartcards for use in information points in GP surgeries, hospitals and walk-in centres. Any option will allow patients to check their summarised and up-to-date healthcare records.

The EHR will have clear benefits for emergency care, as important basic information about the patient can be accessed quickly by NHS professionals whichever hospital the patient happens to be in.

The EHR is a part of a broader investment programme worth £700 million, already funded in the three-year health authority allocations, to give doctors, nurses and patients a wide range of IT facilities to improve and speed up healthcare.

As part of this broader programme, all patients will see benefits between 2002 and 2005:

• all NHS clinical staff will have internet and intranet access including email and online information services by the end of 2002; ensuring that they have access to up to date information and evidence-base;
• doctors and nurses will then be able to use their electronic network to order tests, getting results back faster. In some cases, results will be available a week earlier;
• a national appointment booking system by 2005, will allow all family doctors to book hospital appointments online from the GP surgery, so that patients can choose the time which best suits them, there and then, rather than wait to be given an appointment on a list; and
• all local health services will have facilities for telemedicine by 2005. This will lead to new ways of working eg hospital consultants viewing patients in GP surgeries via electronic links or providing an email or phone service for patients to contact their practice nurse or GP for advice.

Alan Milburn said: "The NHS is still in the last century when it comes to harnessing the benefits of new technology. This investment will help bring the NHS into the 21st century. The electronic health record will help put patients in control. The sustained investment we are making in NHS IT will help redesign the health service around the needs of its patients. In future, every patient will have easier access to their own health records. That will also help make the jobs of NHS staff easier too. At the touch of a button they will be able to summon vital clinical information about a patient without having to wait for paper records to be found. New IT facilities in the NHS will make treatment faster and more convenient for patients and staff alike."

Background

Information for Health was published in September 1998 and set out a seven-year strategic framework for the modernisation of NHS information systems. Information for Health, can be found at: www.doh.gov.uk/nhsexipu/strategy/index.htm

The update to the stategy, Building the Information Core: Implementing the NHS Plan, which was launched in January 2001, can be found at: www.doh.gov.uk/nhsexipu/strategy/overview/

In the last two years, an additional £214m has been made available to support modernisation of NHS information systems. This includes a recurring £79m announced in HSC 1999/243 and a further £3m made recurrently available to health authorities from 2000/01. Additional sums are now being made available as part of the allocations for the next three years. An extra £113m will be provided to the NHS for IM&T investment in 2001/02, increasing to £210m in 2002/03 with £210m also in 2003/04. Further sums will support centrally led initiatives, eg human resource and payroll system.

4. The Electronic Record Development Implementation Programme was launched by PS(H) Gisela Stuart on 17 April 2000. It includes a programme of work exploring the different options for the electronic healthcare record in four local health communities.

Pilot projects

Two of the projects, in Cornwall and South Staffordshire, are developing operational systems while the others, in Tees and Durham, are undertaking other vital research work. The pilots will be subject to independent external evaluation and will be completed by December 2001 with a view to beginning implementation of a common national solution from April 2002 through to March 2005:

• Cornwall & Isles of Scilly Health Authority: a 24-hour view of the EHR for the GP out-of-hours service, working towards the core clinical record to support other services (mental health, cardiac care, diabetic care); and support for implementation of the cardiac and mental health National Service Frameworks;
• South Staffordshire Health Authority: an operational EHR that provides 24 hour support involving ambulance staff, out of hours services, community psychiatric nurses, A&E staff, and social services to trial the EHR prototype and developing a production version;
• Tees Health Authority: Specification of Electronic Health Record contents, and exploring issues associated with sharing electronic data between health and social care, including the requirements for patient/client confidentiality & consent; and
• County Durham Health Authority: developing a technical architecture to be validated against the policies of all local organisations and creating a prototype system.

Other parts of the NHS are already demonstrating the benefits of IT investment:

• Bury Knowle (Oxford) and Hadfield Surgery (Derbyshire) are showing the benefits of enabling patients to be able to directly access their electronic records before, after or at the time of consultation;
• GPs at the Chorleywood Health Centre have telemedicine links with Amersham General Hospital and St Mary's Hospital Paddington. They have also recently initiated an active teledermatology pilot service from Amersham Hospital to GP practices in Beaconsfield;
• NHS Direct and Pinderfields and Pontefract NHS Trust are piloting a scheme to help patients stay at home. By providing portable monitoring equipment, the patient can measure his or her own pulse, oxygen levels and blood pressure which is then transmitted over the telephone to NHS Direct, who will alert the support team if necessary. Specialist nursing care is also provided to help the patient remain at home; and
• videoconferencing and high bandwidth links between accident and emergency and minor injuries units are saving time and travelling for both consultants and patients, as well as enabling better trauma management. A pioneer in this was Central Middlesex Hospital (Mr Sapal Tachakra) with links to Wembley Hospital and now Edgware General Hospital, allowing the nurses and doctors at the remote site to link to the A&E consultant directly for advice.