Wednesday, 28 October 2015

Stand and deliver: your data or your health!

Dr +Nicola Waldman writes to +Which? 

As a GP, I have significant concerns around the practicalities of medical record sharing. Which? ran an article concluding that the NHS should learn from Apple and Google to “modernise” its records systems. However, I fear they overlooked some important details, and have shared my concerns with the editor.

  1. Much NHS data is already managed by private firms
    6 in 10 Which? members surveyed are not happy for their health data to be shared with private firms. I wonder how many of the public are aware that GPs use clinical IT systems owned and managed by private firms to keep their records? The distinction between what data is held within the NHS and what is held by private companies is not one I think is commonly understood.
  2. Pharmacy2U is 20% owned by a GP IT system provider
    EMIS is one of the biggest suppliers of IT systems to GP practices. Pharmacy2U was recently fined for selling patient data. Pharmacy2U is in fact 20% owned by EMIS. Not only that, but the CEO of EMIS, Chris Spencer is also a non-executive director of Pharmacy2U. Private firms already hold vast amounts of patient data. Can we really trust them, after the Pharmacy2U fiasco?
  3. HSCIC cannot process opt-outs
    When the programme was initially rolled out, patients were given the option of “Opting out” of sharing their data. GP practices added a code to the patient’s record which was meant to ensure their data was not shared. Yet the chair of the HSCIC later admitted that the organisation was unable to process the objections, so data could have been shared without consent. If this organisation is unable to manage patient’s data in line with their wishes, what hope is there that those who receive the data will be able to? Thankfully, for this reason, the programme was stalled.
  4. Billions have already been wasted on the goal of NHS IT integration
    Finally, we must not forget the debacle of the National Programme for IT, later known as Connecting For Health. The ambitious IT programme cost billions. It was meant to link all the different IT systems within the NHS together, so the shambles of such situations you rightly point out, where medical records within one part of the NHS are not visible to another became a thing of the past.
    Yet it failed. Prestigious IT companies walked away from their contracts. They could not make the idea a reality. Given that in very recent years, despite eye-watering amounts of money and the best brains around working on the project, it was not found to be possible, should we again pursue this goal?

I agree with the ideal that patients should have a smooth journey through the NHS system with every part of it communicating with the other and with minimal risk of data breaches. I am just not sure that this is feasible. And I am very sure that patients would not understand who holds their data, in what circumstances it would be shared and for what purposes.

Saturday, 3 October 2015

What is a "tick box exercise?"

I often hear criticism of assessment processes as being "tick box exercises". One way to respond to such feedback is for assessors to replace the actual tick box with one or more boxes in which one must record a descriptive account, often to record reflection.

Is this an appropriate response to what critics actually mean by "tick box exercises?" What do they mean?

I suspect the phrase "tick box exercises" is actually often short hand for mandatory, time consuming data collection exercises of little or no value.

Therefore, replacing the tick box with space for a fuller, descriptive response in reality exacerbates the problem, resulting in an even more time consuming exercise; whilst reflection may be documented, it may be at the expense of a more meaningful, less constrained discussion between colleagues working together to improve each other's performance.

Take GP training for example. Experienced GP trainers report being able to predict within 2 weeks whether their trainee will complete their training successfully within the usual time frame. If there are concerns, space to record them in evidence can be helpful. However, if there are no concerns, perhaps all we need is a single tick box at the two week mark!