Data sharing concerns raised by primary care practitioners at Scottish Parliament inquiry
Primary care professionals working on the frontline of health and care in Scotland have aired their concerns about the effectiveness of data sharing between different parts of the NHS and community care providers during a parliamentary inquiry at the Scottish Parliament.
Representatives from professional medical bodies including GPs, dentists, optometrists and pharmacists have raised a series of ICT issues including “clunky IT systems that don’t talk to each other” in a hearing of the Health & Sport Committee at Holyrood on Tuesday morning.
In phase two of the Primary Care Inquiry – which is designed to help politicians understand what health and care services should ‘look like’ for the next generation – expert witnesses agreed that communications channels between service providers are in need of improvement and that patients need to be more in control of their own data.
David McColl, Chair of the Scottish Dental Practice Committee, British Dental Association, said: “We feel that IT integration is crucial to everything that happens in health. And what we have at the minute is clunky IT systems that don’t talk to each other. Even within secondary care they have systems that don’t talk to each other and they can’t measure exactly what they’re doing. We can’t interface with secondary care very well. We have a very, very clunky referral system called SCI Gateway which was a bolt-on service to the dental stuff that we have. It takes about 10 or 15 minutes to fill in any field; there’s nothing that pre-populates and… we need access to electronic care summaries as we spend an inordinate amount of time with patients going through medical histories, getting updated medical histories. And I think if we had that and some type of electronic form it would really help practice.”
Jonathan Burton, Chair, Scottish Pharmacy Board, Royal Pharmaceutical Society, said: “I think it’s fair to say that when you’re talking about integration of healthcare it’s very difficult to integrate services when the professionals within those services can’t easily communicate with one another.
“We see this in pharmacies and community pharmacy practice and it’s echoed across some of the other contractor professions that sit outside the GP surgery model that it’s diffcult for us to get access to patient records. There are changes starting to occur in some areas of Scotland but still access to basic electronic care summaries is not part of commonplace practice in a community pharmacy but also from a pharmacy perspective the range of services and the complexity of the care that we offer is forever increasing and what we’re really also lacking is not just the ability to see records but the ability to populate those records with a record of the care that we’re providing.”
He added: “So that really does limit integration and every minute that you spend struggling to communicate with your colleagues is a minute that takes you away from the patient.”
In papers submitted to the committee in advance of Tuesday morning’s hearing – which had a wide remit including workforce planning, public health and prevention and the creation of multi-disciplinary teams (MDTs) in local health and care provision – there were concerns aired that the National Digital Service, a new national electronic health records (EHR) system was a positive development but that the timescales for its implementation as a nationwide system were too far off.
The submission from the Royal Pharmaceutical Society in Scotland read: “While we support the development of a nation a [sic] digital platform, the timescale for this is too long. Some essential steps need to be taken to decrease the risk to patient safety over the next ten years. Measures will need to be put in place as a priority to provide community pharmacists access to health records. Scotland is now lagging behind England and Wales in this respect. With several professions including pharmacists now independent prescribers it is becoming even more important that all the appropriate information is available before dispensing occurs. The Adastra system could be adapted for a two way system between GPs and community pharmacy and other health care professionals.”
However, at the inquiry Mr Burton said: “What we should be aiming for it a central digitised record that the patient has ownership of. And I think any of the professions that are arguing for increased access to records, increased ability to write into records, we need to be mindful that we need to take patients with us on that journey and consent is absolutely essential.”
Witnesses generally supported the idea that with the development of the General Data Protection Data Regulation (GDPR), that patients should be at the centre of any new records portal and that they should “own the data”, with David Quigley, Chair, Optometry Scotland, saying: “The patient should own the data. I think GDPR determines how contractors are able to use the data.” However, Mr McColl – a dentist from Govanhill in Glasgow – raised the point that contractors such as dentists do not need access to all patient data, just what is relevant to them, and that in order for any system to work properly between service providers it would need to be on some form of cloud-based platform and ideally be “government-led”.
He said: “We would probably rather have one system that was upgraded and maintained throughout the whole of the NHS because I think that would make NHS delivery a lot more easy. It has to be government-led. If you leave it down to individual boards they will all do slightly different things in a slightly different way and we will end up with systems not being able to communicate with each other again.”
In the second of two evidence sessions, GPs were able to participate in a similarly wide-ranging discussion on future-proofing health and care in Scotland. However, the session also focused on ICT with an advanced paper from the Royal College of General Practitioners Scotland saying: “Urgent investment in IT is required to ensure that systems work more effectively together, improving reliability for clinicians and patients.” This was supported by a submission from BMA Scotland, which said: “There is a lack of investment in infrastructure to accommodate community care staff – who require good IT connectivity between them – and replace facilities that have outlived their use.”
In the session itself, on a fairly general question from MSPs about the state of IT, Dr Andrew Buist, Chair of the Scottish GP Commitee, BMA Scotland, said: “We rely on our computers when we’re in the surgery but when we’re on a home visit we don’t have access to that; we can’t see when they [patients] last had a blood test, we can’t read a hospital letter that arrived the previous week. The technology exists that we could have access to that information on home visiting and often that makes a huge difference as to what you decide to do. It’s an issue in the out-of-hours period, too, where sometimes the out-of-hours doctors are working without access to the patient records. So we need to do something about this.”
Dr Carey Lunan, Chair, the Royal College of General Practitioners Scotland, added that a survey of doctors in 2015 pointed to a need for basic IT systems to work better – over the high-tech telemedicine solutions – and that was still the ongoing priority among general practitioners.
She said: “Unless we’ve got basic IT that works really well and it’s efficient and it’s reliable and it’s safe, then none of the other stuff can follow. It’s crucial to safe interface of care to be able to share data across the acute setting and the community setting, and that’s missing. Patients expect us to be able to see what’s happening to them in hospital and they expect teams of consultants and people looking after them in hospital to be able to see what’s happening in the community, and that doesn’t happen. They’re always surprised about that.”
Dr Carey also spoke from personal experience as having been a clinical lead for anticipatory care – whereby patients with complex needs are catered for by way of a care plan that is shared between different community healthcare providers.
She said: “I have a big interest in this having done this for five years as a clinical lead, so GPs can and other members of the primary care team will create care plans for the patients who have got complex health and social care needs using a piece of IT called the key information summary, which can then be shared across interfaces but it doesn’t work well. So you can see it well in the out-of-hours setting but you can’t always see it in the hospital setting, you can’t see it in the community pharmacy setting; you can’t see it in the care home setting, you can’t see it in the social care setting, so all these very difficult conversations that have been recorded about patients’ beliefs, patients’ desires, wishes about how far they want treatment to go, is not being seen at the time that it needs to be seen.”
She added: “It can’t be seen by ambulance services on the way to an emergency; there are significant issues about being able to communicate patients’ wishes about what they want to happen that are not happening at the moment. Now I know that that there’s work being done in NES around the shared digital platform that will link up health and social care [that will be] much more collaborative. I’m not sure what the timescales are for that but I think we would all say that it can’t come soon enough.”