Electronic health records in England

The publication of Personalised Health and Care 2020 by the Department of Health elaborated a new attempt to integrate patient records.[7] Its stated ambition was that every citizen would be able securely to access their health records online by 2018 and make real time data available to paramedics, doctors and nurses.[8] A real time record across health and social care is seen as the key to the provision of integrated care.[9]

Transferring hospital records to electronic systems has generally been much slower and more difficult than in primary care, apart from clinical imaging, which has been largely electronic for several years. In 2019 only 10% of NHS trusts claimed to be fully digitised. Plans for a paperless NHS by 2020 are clearly not going to be realised. The NHS Long Term Plan requires all hospitals to move to digital records by 2023, so clinicians can access and interact with patient records and care plans wherever they are. 62% of trusts have plans to digitise all their patient records.[10]

GP2GP is an NHS Connecting for Health project in the United Kingdom. It enables GPs to transfer a patient's electronic medical record to another practice when the patient moves onto the list.[11] In General Practice in the UK the medical record has been computerized for many years, in fact the UK is probably one of the world leaders in this field. There are very few General Practices in the UK which are not computerized. Unlike the USA GP's have not had to deal with billing and have been able to concentrate on clinical care. The GP record is separate from the national Care Record and contains far more data. Shaun O'Hanlon, EMIS's Chief Clinical Officer says that the legal framework around data sharing is the main problem in integrating patient data because the Data Protection Act 1998 puts responsibilities on GPs to protect the confidentiality of patient data, but at the same time they have a "duty to share" when it is in the best interests of the patient. He says the quickest, easiest route to large scale record sharing is to put patients in the driving seat using smartphone technology. He quotes a YouGov poll which found that 85% of the population wanted any medical professional directly responsible for their treatment to have secure electronic access to key data from their GP record, such as long term conditions, medication history or allergies.[12]

Clinical IT suppliers are moving towards greater interoperability, already achieved with the GP2GP project allowing different systems to exchange complete medical records between practices. There are projects allowing access between hospitals & GP practices. The main Primary Care systems are EMIS Health, SystmOne, iSOFT, and INPS Vision. The NHS in Scotland widely used GPASS until 2012. From April 2014 practices are contractually required to promote and offer patients the opportunity to book appointments online, order repeat prescriptions online and provide online patient record access.[13]

The assistant coroner for inner north London has twice written to Jeremy Hunt warning that “future deaths could occur [if] further action is not taken to facilitate secondary care access to GP records”.[14]

Leeds was the first city to implement the NHS Digital programme GP Connect. This makes patient records available across care settings, including social care, general practice, community, mental health and hospitals.[15]

It has been possible for patients to access their own medical records online for some time. By 2013, the debates had moved onto discussing the impact of patient access on patient care.[16]

• NHS Connecting for Health
• Patient record access in the United Kingdom