The discrepancy between the latest survey on the Summary Care Record and the University College London findings is readily explained by sampling bias.
UCL used a dataset, supplied by Adastra, of 416,325 consultations in three participating care-record sites. All consultations over an 18-month period were included, representing 322 doctors and nurses. All doctors and nurses were included, whether or not they chose to participate or were regular users of the care record. In that dataset, the overall rate of its use was 4% (using the denominator ‘all patients’) and 21% (using the denominator ‘all patients in whom a Summary Care Record existed’). Different sites had different patterns of adoption – in one site the rate of use was rising rapidly, in another more slowly and in a third it was falling.
In terms of benefits, we did witness one or two examples of benefits and heard anecdotal stories from clinicians similar to those reported in Pulse. But we also collected numerous complaints from staff about the high workload of implementation and poor quality of data. We observed many cases of staff choosing not to access patients’ care records and in which data was incomplete or inaccurate.
We concluded that although the care record can provide information that adds value to the consultation, this is only occurring rarely and the benefits achieved are much more limited than those predicted in early policy documents.
We were disappointed in these findings, since our team began the study with broadly positive attitudes to the care record. I myself am a practising GP and know how frustrating it is to see patients without key background details. But it would have been dishonest to distort the figures to imply that either use or benefits were higher than they actually were.
I have the highest regard for Dr Gillian Braunold as a clinician. And the senior executives at Adastra are committed to producing a technology that works. But the findings of a survey conducted by Adastra and published without peer review by Dr Braunold in her capacity as guest editor of Pulse must be interpreted in the light of their known conflicts of interest: Dr Braunold is the national clinical director for the Summary Care Record and Adastra makes the software.
From Professor Trisha Greenhalgh
Principal investigator, SCR Independent Evaluation