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The debate about the implementation of electronic patient records (EPR) is increasing in volume and the early adopters process is gathering pace. As media coverage increases, patients will turn to local health professionals for more information, or to voice their concerns, so nurses must have the facts at their disposal to help them make an informed decision.

The summary care record
The summary care record (SCR) will improve patient care by making essential clinical information available to all clinicians involved in treating a patient.

A patient can be treated in a number of healthcare settings and frequently there are not any notes available.

It is not the complete GP record, but its essential elements, which contribute to the SCR and help to ensure safer care wherever the patient is treated.

Do patients have a choice?
The consent model and choices for patients have evolved over the past months. Following the ministerial task force report last November there was a recommendation that no patient should be obliged to have an SCR created.

This policy enables patients to have a high level of control and choice regarding how their records are shared.

I could not lead this programme unless I could answer the following with confidence: can patients refuse to have a summary? Can patients change their minds at any stage? Can patients limit what is shared? The answer to all three is 'yes'.

Patients have three options for how their information should be stored and accessed (see above).

Patients can decide whether or not to have an SCR and, if they choose to have one, whether or not it is shared.

They can change their minds about how their information should be stored and accessed at any time - now or in the future. The patient controls how and where the information is used.

As the diagram above demonstrates, patients with any misgivings about the SCR can decide to have a record created but not to share it routinely (amber).

Should a patient wish, he or she can give permission to a clinician to access the SCR but can stipulate that the permission exists only for the period of that consultation.

When this happens an alert will be sent to the Caldicott guardian responsible for information governance for the trust, creating an indelible footprint. Choosing the amber box gives patients maximum control over an SCR.

Patient control via HealthSpace
By registering to use a secure website called HealthSpace, patients can access their own records. The website will enable them to share their SCR in a variety of ways, such as printing it out or logging into their HealthSpace account while in the company of a clinician. This could be especially useful when outside England or, in the short-term, in areas where the SCR has not yet been adopted.

Patients who have chosen not to share their data routinely will be able to view their SCR through HealthSpace.

Allaying security fears
Much of the media debate has focused on security fears, but access to SCRs is strictly controlled. A clinician must have access rights for their organisation and their role, as well as a legitimate reason for seeing the record.

A&E departments, the GP out-of-hours service and ambulance services will have access to the SCRs of patients who attend.

Patients must be able to be identified in these settings for their summary record to be made available. Additionally, and under the same rigorous controls, registered and authenticated community staff will have access to the SCRs of patients with long-term conditions for whom they provide care. Similarly, HealthSpace has strict registration and access controls.

The first to use SCRs
Early-adopter areas are populating patients' SCRs with limited but important clinical information from their GPs. Patients are informed and given four months to decide on the extent of their participation.

During this period the practice's data is checked for quality and accuracy, according to the information management and technology directed enhanced service.

After 16 weeks, practices will upload a limited part of the record: current medications, allergies and adverse reactions only. This will only apply to patients who have agreed to store an SCR.

Following this initial upload, significant medical history and other key information will only be added after discussion with the patient.

Early adopter PCTs are working with Connecting for Health on the post-upload stage, to ensure that the maintenance of a meaningful summary is managed effectively.

Dr Braunold is a GP in London and clinical lead for the SCR Early Adopter Programme.

PATIENTS' OPTIONS FOR HOW THEIR INFORMATION IS STORED AND ACCESSED

GREEN: STORE AND SHARE
Clinician - via SCR

• A summary record (SCR) is visible to an authorised user who has a legitimate relationship to that patient.

Patient - via HealthSpace

• The patient's SCR is visible to the patient.

AMBER: STORE ONLY
Clinician - via SCR

• An SCR will exist but will not be automatically visible to any authorised user.
• The patient may give a clinician permission to override the share status and view the record.
• The status can only be overriden without a patient's permission by a court order or statute.

Patient - via HealthSpace

• The patient's SCR is visible to that patient only.

RED: DON'T STORE, DON'T SHARE
Clinician - via SCR

• A blank summary is created, stating that the patient did not want to have a summary record.

Patient - via HealthSpace

• No clinical data is available. A note confirming this is visible.