Headlines: June 30th, 2006

Opposing systems for sharing electronic patient records in the National Health Service are examined in today’s British Medical Journal. It says that while the potential benefits of sharing records within health systems are broadly agreed there are still concerns over patient consent and security. Experts writing in the Journal discuss how patients should consent to the use of electronic records and how data can be kept secure.The BMJ looks at the two broad schools of thought, the so-called opt-out and opt in models. Under the first of these patients would be informed of the NHS care records service and to be given a chance to opt out if they do not want their clinical records shared within the NHS. The second model is for no sharing to happen until people state their desire for this to take place

Nigel Watson, the Chief Executive of Wessex Local Medical Committees, who has experienced an opt-out approach, believes this is the way forward. He cites existing schemes that have been widely accepted by health professionals and the public, including the scheme in Alberta in Canada. That was changed from an opt-in position in 2003 after consultation with patients and professionals.

In his article he says that in his own area, Hampshire and the Isle of Wight, only 1,150 of the 1.3 million patients have decided not to have their records included in the repository. He believes the NHS care record service should choose an opt-out system, which would allow patients to benefit from earlier availability of information, he says, and reduce both the workload on hard pressed services and bureaucracy.

Mr. Watson, though, stresses the need for a publicity campaign six months before the service comes into operation to tell patients what is going to happen and to highlight the potential benefits and dangers as well as how they can opt out of record sharing.

The opposite view is set out by Dr John Halamka, Chief Information Officer at Harvard Medical School, who argues that opting in is the only way to ensure confidentiality. He details regional data sharing in the United States and says patients are best served by seeking their permission to include their data in the regional index. Both systems, he says, have risks and benefits.