Ch 8e scr ecs

Chapter 8e - The Summary Care Record and the Emergency Care Summary

8e.1 Introduction¶

The Summary Care Record (SCR)^1 in England and the Emergency Care Summary (ECS)^2 in Scotland are resources designed to assist in the management of patients in urgent and emergency care settings (OOH/NHS24/A+E etc). Each resource is populated by selective extracts from the GP record. In both cases, the core extract consists of all current repeat medication and all allergies/adverse reactions identified in the source record. The SCR also includes recently discontinued repeat medication and any acute medication issued in the previous six months.

The SCR is capable of being added to with more coded data and associated free text, subject to the decisions of the patient and responsible clinician.

The ECS does not accept additional coded data in the summary itself but information relating to the gold standard for palliative care^3 may be uploaded if the patient gives prior consent.

Wales are deploying an Individual Health record, which has been implemented in Gwent and is now available to other Health Boards for rollout. Northern Ireland are also developing an Emergency Care Summary which should be rolled out to the Southern Trust during 2011.

The consent models for the SCR^4 and ECS^5 are similar but differ in some details. For the SCR, a core extract is sent on the basis of implied consent. Access is allowed only if the patient gives explicit consent but that consent requirement may be overridden in the case of emergency (where, for instance, the patient is comatose). Each patient may opt not to have a summary care record (and to have existing records deleted subject to a board review). If they opt to have an SCR, then they may decide to require to be asked each time it is accessed - or to give free access to those responsible for their care. The former option is the default one. For each patient his or her consent status is recorded on the local system using a flag or Read code. It is clearly important to record that status accurately so that, on the one hand, information is included in the SCR that should be, and on the other, that information is not sent when the patient has opted out.

Adding further codes/text to the record will only occur on the basis of a decision taken by the clinician/patient and requires explicit consent by the patient.

For the ECS, a core extract is sent on the basis of implied consent. Access is also determined by explicit consent except in the case of emergency. No enrichment of the ECS record is currently possible except in the case of palliative care settings. In the latter case, explicit consent needs to be given before the upload of the agreed dataset.

8e.3 Data quality¶

The general requirements for data quality described elsewhere in this document apply (see also chapter 6). Some specific considerations are detailed below:

8e.3.1 Medication¶

It should be recognised that the remote user of the SCR/ECS will not have access to the whole source record or, in most cases, familiarity with the patients concerned. In these circumstances, it is more than usually important to ensure the completeness and accuracy of the medication record by;

Engaging in timely medication reviews
Entering handwritten prescriptions in the electronic record
Entering medication prescribed and dispensed in another care setting
Entering regular OTC medication where possible

8e.3.2 General clinical codes¶

Where it is decided to add codes and text to a summary care record beyond the core set, it is highly desirable that this should be done as consistently as possible so that the end clinical user of the record may have some confidence in the reliability of the information presented both in terms of what would be expected to be included and what would normally be excluded.

Clearly, there will be some differences in enriched records both because different platforms handle the summarisation of record content differently, and because different users will adopt different conventions of usage of their systems.

Having said that, the RCGP has produced a set of recommendations^6 for the enriched content of the GP Summary in the SCR which include the following general categories:

Major diagnoses
Conditions that may have a chronic or relapsing course
Conditions for which the patient receives repeat medications
Conditions that are persistent and serious contraindications for classes of medication
Major operations
Significant therapies & treatment plans
Significant investigations
Fractures
Immunisations

How this is achieved will, to some extent, be platform dependent. However, in order to reach this end, some general requirements will need to be present including:

Practices will need to have a reliable and timely process for summarising the records of new patients
Practices will need to have a comprehensive policy for capturing significant diagnoses and events made or occurring in primary care
Practices will need to have a reliable process for coding significant diagnoses and events made or occurring in other care settings
Practices will need to maintain the completeness, relevance and contemporaneousness of local problem lists

Finally, it is important to recognise that the ultimate responsibility for the completeness and accuracy of the content of the SCR/ECS will rest with the authors of the source (GP) record.

In addition to the need to include clinical codes consistently, there is a similar equivalent need to exclude sensitive data. An exclusion dataset has been defined for use by suppliers so that a range of codes relating to sexually transmitted diseases/HIV, human fertilisation/embryology, abortion and gender recognition will be automatically excluded from any SCR upload. That dataset will be subject to ongoing review and it may be overridden by patient/clinician agreement if the patient decides to share items that otherwise would not be included in the SCR.

There may, of course, be information outside these areas, which might be deemed to be sensitive either generally or in individual circumstances. In such cases, responsible clinicians will need to flag such entries as "not for inclusion" in a summary care record. The mechanism for doing this will vary from platform to platform (See also Chapters 6, 7, 9 & 12).

8e.3.3 Smartcards¶

As with all other spine functions in England, access is determined by smartcard usage and the role based access permissions associated with them (see also chapter 4). Record entries made when not logged on using a smartcard or using the wrong role will not update the summary care record. The consequence of this is that the summary will not be updated in line with the local record, resulting in potential clinical error if decisions are made on the basis of erroneous information. The consequence of this is that it is important to ensure that all clinical users including temporary staff have smartcards with appropriate role based access when entering clinical data.