Reply to: Summary care records

[MarillionFan]

Rightio. I actually worked on a team that was responsible for developing the software to migrate GP records. So if you want to break into a surgery and nick their hardrive, I have the software to decode at least 8 of them including EMIS, Torex, Synergy, Exeter, Seetec.

Cost you though!!!

[minestrone]

I'm not debating banks, neither do I want to. Whatever they do is done. Please, forget bloody banks and stay on the subject of summary care records.

I agree with you that such a database is desirable but I'm not happy with the potential for reduced security or privacy. Someone hacking or misusing a nationwide database is a lot easier than breaking into doctors' surgeries at night.

Absolute nonsense, I could be in and out of a surgery in 2 minutes, the police will not rush to go to a surgery if the alarm is going off, chemist yes but not a surgery. Really it does not need to be that hard, fairly common for surgeries to hire temp staff to do some file admin tasks, easy to get a job. The easiest way really is to instigate a file transfer but I won't go into the specifics of that online.

Any of these is going to be easier, far far easier than cracking a secure database. If it was that easy the police database would have been done over already and it never has.

Believe me, if I wanted to get to your file I would be able to get to it.

[Doggy Styles]

That's a bit long, but goes some way toward the assurance I am interested in. I too worked on NPfIT, although on a different project to SPINE.

I now work at a financial institution, and independent tecky types make breakthroughs in cracking security measures.

[Board Game Geek]

Someone quoted :

I'd feel a little safer not having all my aches and pains available for scrutiny.

Right. I hope I can set the record straight on this Summary Care Record, as I am involved in part of this project from a technical and also advice point of view.

First, a little bit of background prior to the SCR.

There is already a national database on the NHS Spine, which, with previous patient consent, holds the following information.

This is called the Spine Record, for argument's sake.

Spine Record : Name / DOB / Address / NHS Number

That's been around for several years now. No other information is stored upon it.

The SCR will collect specific, and only specific, information from your surgery held medical record, and upload it to the Spine Record.

What information will it upload ?

Basically, anything that is critical to emergency/acute care or necessary to provide care without harming the patient.

Therefore for the majority of people, nothing will infact be uploaded.

However, if you have a serious illness and need specialist treatment or have adverse reactions to certain drugs, then this will be uploaded.

Eg, "Severe Allergy / Contraindication to Penicillin"
"MS Patient"
"Peanut Allergy"
"Cancer patient"
etc

What the SCR won't detail or collect is every medical appointment for non-critical or non-actute care. It's simply not necessary. If you had your tonsils out at age 8, that won't go on there. If you saw the doc about the "ahem...problem down there", that's wont go on there.

Basically, it's stuff that can save your life in an emergency.

So why do it then ? What's the point ?

It's about "sharing information".

If Patient X with a severe reaction to drug X, is involved in an accident, and perhaps unconcious, they get wheeled in to A&E and the medical professionals have a dilemma.

Hopefully the patient may have ID, and they can try and contact NOK, to inform them of the accident, and also ask if the patient in on any medications or had allergic reactions. (Assuming the patient has told their family of course. Some people are private in this regards. Also, this is assuming the NOK are contactable.)

This takes time, while patient X is in a critical situation, and there is a lot of faffing about trying to get in contact with people. If they do have ID, then they might be able, again after a lot of seaching, to get the patient's surgery details, and phone the surgery. Let's hope the patient had an accident during the surgery's opening hours, eh ?

SCR does away with all that.

Doctor/Nurse logs in to SCR with their role-based smartcard. The clinical role allows them to check the patient's record.

BUT

1st question before they see the record is :

"Do you have the patient's explicit consent to view this record ?" Y/N (or something to this effect)

If they answer No, then it will ask "Why do you not have explicit consent" ? (Detail Below)

The Doctor/Nurse then has to say why, eg "Patient unconscious"

There are a few more questions, then they will get access to the record, to get the information they need quickly to administer the right treatment without harming the patient.

HOWEVER

Because they said that no consent was given, this access is "flagged for investigation."

At some point, the Doctor will receive a follow up to check that the access was legitimate. I am not sure if this is a phone call, or possibly even a "visit" from somone in Information Governance.

Not every medical professional will be able to access the SCR.

Eg, I have a smartcard but my role is Technical, so all I can do is log on to the home page of the Spine, to check that it loads on a Doctor's PC. I cannot access any clinical data beyond that. Even that login is audited however.

Personally, I am in favour of the SCR, as I know it only holds information about me essential to providing me emergency acute care, or information relevant to my condition. If I'm not in the position to tell the emergency medical professionals certain information, then I'm more happier them accessing my record to get what they need, rather than then faffing about trying to contact my NOK, whilst the clock ticks in the background.

It's too late to wish you had of let them have access, when you're laying lifeless on the operating theatre.

YMMVH

By the way, some surgery's have clinical servers onsite that hold the patient's whole record in a medical 3rd party database. Some surgery's have a file server for domain login, but their clinical data is held off-site and accessed by encryption in to a web browser via smartcard role.

I cannot comment on the former, but I have faith in the latter.

[Doggy Styles]

Well again we come back to the question...

"but do you seek assurances from banks when you open an account on the safety of your details?"

Your point...

"That genie is out of the bottle, the NHS database isn't"

...was as I read it "the banks were allowed to do it then but if I applied my reasoning on database security to the banking system as I am applying to the NHS system then I would not want to have a bank account"

Again I do honestly say that it is easy to read a strangers medical records if you are inclined to do so.

I'm not debating banks, neither do I want to. Whatever they do is done. Please, forget bloody banks and stay on the subject of summary care records.

I agree with you that such a database is desirable but I'm not happy with the potential for reduced security or privacy. Someone hacking or misusing a nationwide database is a lot easier than breaking into doctors' surgeries at night.

[minestrone]

A director of the local NHS trust ( I should not name drop, Robert De Niro told me that) is coming round for drinks later, if I get a chance i'll ask her about this.

Never got a chance to quiz her on this, her Husband and I talked about the garden, mono blocks and the x box while the burd and her talked about wallpaper.

[minestrone]

I said no such thing, or even suggested it. Why are you putting words into my mouth?

I said that I like the idea of an NHS database, but before it is implemented I'd want assurances that my NHS data is only being used for purpose.

Well again we come back to the question...

"but do you seek assurances from banks when you open an account on the safety of your details?"

Your point...

"That genie is out of the bottle, the NHS database isn't"

...was as I read it "the banks were allowed to do it then but if I applied my reasoning on database security to the banking system as I am applying to the NHS system then I would not want to have a bank account"

Again I do honestly say that it is easy to read a strangers medical records if you are inclined to do so.

[Doggy Styles]

Does that mean you would prefer if banks got rid of databases and went back to paper? You obviously think a paper based system is safer.

I said no such thing, or even suggested it. Why are you putting words into my mouth?

I said that I like the idea of an NHS database, but before it is implemented I'd want assurances that my NHS data is only being used for purpose.

[minestrone]

That genie is out of the bottle, the NHS database isn't, so it's irrelevant.

Does that mean you would prefer if banks got rid of databases and went back to paper? You obviously think a paper based system is safer.

[Doggy Styles]

but do you seek assurances from banks when you open an account on the safety of your details?

That genie is out of the bottle, the NHS database isn't, so it's irrelevant.

[Clippy]

Part of the problem of lack of confidence is due to offshoring.

Once you have this database, the next logical step is to offshore its maintenance/management.

It's difficult to trust a spotty IT support kid based in the UK let alone Bob in Bangalore.

Further, wasn't there also talk of other bodies having access to these records like your local council. Why exactly??

[minestrone]

but do you seek assurances from banks when you open an account on the safety of your details?

The most similar application to the one they are building is the police criminal system which I worked on, it has been running for decades and has never been breached. There are times when some junior assistant looks up someone famous but the get caught very quickly as their is an audit trail and there are people watching what is being looked at. I know a doctor in Scotland lost his job becasue he was looking up BBC scotland b list stars medical records so that system is in place in the NHS and is working.

A director of the local NHS trust ( I should not name drop, Robert De Niro told me that) is coming round for drinks later, if I get a chance i'll ask her about this.

I did know a GP who was on the project board and resigned, never asked for an opinion and realised very quickly he was only there if things went wrong the politicians could say "we had a doctor involved at every discussion". Labour made this whole thing a political mess.

[Doggy Styles]

I am shocked, I placed a post on here yesterday in support of a national health database and nobody has replied to counter what I said.

I hoped my post would encourage the usual paranoid ramblings of the left of centre mob and I must say I have failed.

I will take it you all agree with what I have said.

I agree with you.

But I'd want assurance that my data could only be used for the stated purpose it is held, which at the moment is much more likely if it were held on that crappy database held in the doctor's surgery.

How can everyone be assured of that?

[minestrone]

I am shocked, I placed a post on here yesterday in support of a national health database and nobody has replied to counter what I said.

I hoped my post would encourage the usual paranoid ramblings of the left of centre mob and I must say I have failed.

I will take it you all agree with what I have said.

[minestrone]

I have personally been told of three deaths due to record mistakes, there are hundreds more every year, the current system is a total disaster and needs to be changed.

Like it or not your medical details will be on a database currently, probably on a crappy server in some unsecured surgery. Your details will also be in paper in that surgery and would take anyone with half a brain less than a week to get at it.

This again is political interfering in how the NHS works led by screaming bedwetting Luddites in the public.