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Thou shalt smite smokers (and eaters of fry-ups)

By Ian Cameron

Technical problems with the planned national electronic patient record mean there will be no 'sealed envelope' of sensitive patient information when it is rolled out next year.

The sealed envelope was envisaged as the means to protect patient confidentiality while ensuring doctors could gain access to vital patient data in an emergency.

But Harry Cayton, chair of the Care Record Development Board, admitted last week that the first release of the record, expected in late summer next year, would have to go ahead without it.

Patients will still be able to withhold sensitive information, Mr Cayton told a conference on the Care Record, but doctors are likely to only be able to see a 'flagging' system that indicates the record is incomplete.

Mr Cayton admitted even this aspect was not guaranteed.

GPs said the decision to go ahead without the sealed envelope could damage patient safety. An incomplete record, they argued, could cause more problems than no record at all.

Dr Richard Fitton, a GP in Glossop, Gloucestershire, and until recently a member of the Care Record Development Board, said the designers of the record did not have sufficient grip on the issues surrounding confidentiality.

He added: 'If we don't get informed consent and confidentiality right this thing won't work.'

Dr Mary Hawking, a GP in Dunstable, Bedfordshire, said the delay suggested the development of the Care Records was

'being pushed forward politically at a speed neither the

concept nor the technology can support'.

Simon Eccles, an A&E consultant and one of Connecting for Health's clinical leads, defended the decision to allow an imcomplete record.

He said: 'If I believe I have a full record and I don't that could be a problem.

'There needs to be a flagging system. That's something we are sorting out at the moment but it is subject to technical availability.'

What is the 'sealed envelope'?

· a section in a shared electronic record that can be opened only in emergencies or with consent of the patient

· contains sensitive information such as HIV status, terminations, mental health conditions and sexual problems

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