The Single Shared Electronic Patient Record (SSEPR): problems with functionality and governance.

The GP Electronic Patient Record (GP-EPR) is undoubtedly one of the success stories in general practice in the UK. Since I came into practice in 1979, GP records have gone from being paper-based in Lloyd George envelopes (approximately A5 size cardboard record envelopes) to highly computerised and structured records, with a corresponding revolution in their usefulness – and purposes to which they can be put: who would have dreamed of QOF (Quality and Outcome Framework: introduced in the new GMS contract in 2003 to measure quality of care for selected chronic conditions in general practice, for performance related pay. It depends on entering information into the GP computer system) and QMAS (The Quality Management and Analysis System, known as QMAS, is a national IT system which gives GP practices and Primary Care Trusts (PCTs) objective evidence and feedback on the quality of care delivered to patients. It supports the Quality and Outcomes (QOF) element of the GP contract and has been in operation since 2004. This sea-change in record keeping was driven both by enthusiasts who could see the potential for patient care – and successive governments who could see possibilities as well. I am becoming increasingly concerned about the future of this success story. One of the requirements in NPfIT (the English NHS National Programme for Information Technology) is for a single electronic medical record for every patient, used and contributed to by all healthcare professionals involved in the care of that patient. Let's call this new record the SSEPR to differentiate if from the Summary Care Record held by the Personal Spine Information Service (PSIS) and the Detailed Care Record (DCR) which is yet to be precisely defined but may be similar to the SSEPR. Current examples are CSC/TPP SystmOne (Clinical Science Partnership/The Phoenix Partnership) for primary care and in the near future Lorenzo, which is planned (presentation by CSC at the East of England event 'Improving Lives Saving Lives – the future of NPfIT' 6/12/07 http://etdevents.connecting forhealth. nhs.uk/1307 PowerPoint by Simon Holt) apparently, to include hospital, GP and community records. Looking at the only functioning model (CSC/TPP SystmOne), there would seem to be a lack of agreement about both the functions of the record and its governance. Leaving aside the very important issues of access and consent – the Caldicott Guardian and Data Controller aspects – at present only the organisation entering data (which includes prescriptions) can …