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No proof of Summary Care Record benefit, official evaluation finds

By Ian Quinn

The Government's electronic patient record is of little use in A&E and frequently fails during out-of-hours work, the latest report from the official evaluation of the scheme admits.

Researchers investigating the effectiveness of the care record have collated 20,000 words and more than 100 case studies in a two-year probe, but are yet to come up with any solid evidence of benefit, Pulse can reveal.

The University College London interim report to the Summary Care Record Advisory Group reveals gaping holes where Connecting for Health had hoped for evidence that it could improve acute and out-of-hours care.

Connecting for Health managers insisted it was still too early to judge the rollout and claimed there had been some tentative signs it was adding value in primary care.

But the situation is more difficult in A&E where the few hospitals to start using the record have found it of little use, according to the report.

Led by Professor Trish Greenhalgh, professor of primary healthcare at UCL, the interim report concluded: ‘Information needed to manage unconscious and other major patients is predominantly real-time, rapidly changing data on the patient's here-and-now condition.'

It said this was ill-matched to the care record, which was a ‘historical', relatively static document' and ‘seems to make a limited contribution in most acutely sick patients'.

IT problems are also dogging the rollout in A&E, out-of-hours and walk-in centres. ‘When available the SCR sometimes adds value in complex clinical, psychological and social cases [in primary care],' the report says. ‘However, in many cases it is not available or accessible.'

When available it ‘may introduce new risks,' it adds, with information not always reliable.

Dr Gillian Braunold, clinical director for the Summary Care Record, insisted there were some positive signs.

‘There are emerging benefits for out-of-hours and walk in centres,' she said, while admitting ‘a whole series of issues need to be tackled.'

Dr Braunold said hospitals would only begin to benefit properly once the record achieved critical mass, something which is still some way away, even after more than two years of the rollout.

‘The Government has invested an enormous amount to get this off the ground and it would be very foolish to try to make conclusions now,' she said.

But Dr Mark McCartney, a GP in Pensilva, Cornwall, said the report ‘struggles to demonstrate any significant benefit'.

‘Given the now-acknowledged risks of use of the SCR in these settings and the enormous cost, I wonder again if consideration will be given to scaling things back.'

Dr Grant Ingrams, the GPC's spokesman on IT, said: ‘I don't believe there will ever come a day when a patient is wheeled into A&E and the first thing the receiving doctor shouts is "get the SCR''.'

The Summary Care Record is of little use in A&E, an official report warns The Summary Care Record is of little use in A&E, an official report warns Theory versus reality

One of Connecting for Health's key aims for the Summary Care Record was to improve ‘access and responsiveness in the acute situation' as one of the key aims of the programme. This was to include:

• ‘prompt and appropriate assessment by the primary care out-of-hours service'
• ‘prompt and appropriate assessment in A&E departments'

UCL reports the SCR ‘sometimes adds value' in out-of-hours, although these are ‘tentative suggestions' not firm conclusions.

In A&E the care record is making a ‘limited contribution in most acutely sick patients'. Pulse reported earlier this year how the Royal Bolton Hospital A&E department, one of the first to use the system, had to abandon plans to access records, except on the specific request of doctors and even then by printing out hard copies, because it was too ‘cumbersome' and leading to queues in A&E.

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