Introduction to the
Summary Care Record (SCR)
• Upload Module
SCR Concept Training Upload Module Presentation v0.01 05-08-14
Contents
Introduction to the SCR
Content of
the SCR
Informing
Patients
Patient
Choice
Consent
Model
Recording
Consent
Security
Practice
Activities
Viewing
SCRs
How the
SCR looks
Further Information
What is the SCR?
The SCR is:
•
•
•
•
An electronic patient summary containing key clinical
information
Accessible by authorised healthcare staff treating
patients in urgent or emergency care settings
Optional - a patient can choose to have or not have an
SCR
Only accessible with permission from the patient
(except for exceptional circumstances e.g. emergency
access if the patient is unconscious)
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Purpose of the Summary Care
Record
•
•
To improve the safety and quality of patient care
by providing key clinical information to
healthcare staff in urgent and emergency
situations.
For example, when a patient needs care at an
Emergency Department or Out of Hours service
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Benefits of Summary Care Records
•
Improving Patient Safety - supporting safer and
more informed prescribing by providing timely access to
accurate information
•
Improving the Efficiency of Patient Care reducing the time, effort and resources required to obtain
this information from the patient’s GP surgery
•
Improving the Effectiveness of Patient Care supporting the delivery of appropriate care to patients
•
Improving Patient Experience - reducing the
requirement on the patient to recall / repeat their medication
information and supporting people with difficulties
communicating
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Content of the SCR
SCR Content – Core Data
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•
The SCR is generated with clinical information
provided by the patient’s registered GP practice
The SCR consists of the following core data
items:
1. Allergies
2. Adverse Reactions
•
3. Medication (Repeat, Acute and Discontinued
Repeats) as per the patients prescription(s)
When a GP practice is live with SCR any changes
made to these core data items will be updated in
the SCR automatically
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SCR Content – Additional Information
• Additional clinical information over and above the
core data items can be added to the SCR by the
patients GP with express patient permission
• Examples of information added to the SCR include:
• Significant diagnoses
• Care plan information (e.g. end of life, long term
conditions)
• Any other information that is considered relevant by the
patient and GP, such as patient preferences
Patients are in control of their SCR and must provide consent
for additional information to be added.
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SCR content
GP
Summary
Update
GP
Summary
containing:
Containing:
•
Medication
•Core
Data or
•
Allergies
•
Adverse reactions
•Core Data &
Additional Information
GP Practice
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Informing Patients
Public Information Programme
• The Public Information Programme (PIP) was an
information campaign co-ordinated by the Health
Organisation to inform patients, the public and NHS staff
about the SCR and the choices available. The PIP lasted
a minimum of 12 weeks
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PIP in GP Practices
In addition to the patient information pack sent to all
patients over 16 years of age registered with a GP
and to ensure that patients are adequately informed
about SCR, the practices should have:
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•
•
•
•
Informed patients that the SCR is available
Made posters available
Made opt out forms available
Answered patient queries
Have a New Patient registration process
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Patient Choice
Patient Choice
•
Creation of an SCR
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Patients can choose whether or not to have an
SCR
Patients can change their mind at any time by
informing their GP practice
Content of the SCR
–
–
Patients can choose if they want additional
information added to their SCR
Patients can choose which additional
information they want adding to their SCR
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Patient Choice - continued
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Viewing an SCR
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–
–
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Patients are asked for their permission every
time healthcare staff need to view their record
Permission to view can be asked and granted
for a group of healthcare staff e.g. an
Emergency Department clinical team
If a patient is unable to grant permission to
view e.g. they are unconscious, a clinician
may choose to use emergency access to view
the SCR if they believe it to be in the patient’s
best interests
SCR Consent Model
Creating the Record:
Do you want a Summary Care Record?
YES
NO
Do nothing and a
record will be
created for you.
Inform your GP Practice
of your choice and
no record will
be created.
Viewing the Record:
Can I/we look at your Summary Care Record?
When you present for
care, you will be
asked* if your
record can
be viewed.
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*In an emergency where you are unable to be asked, or certain medical/legal circumstances (such as Court Order)
the clinicians involved in your care may access the record without asking. All such actions will be recorded for investigation.
Informed implied consent:
Do you want to have a Summary Care
Record?
YES
Do nothing and a
record will be
created for you.
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NO
Inform your GP Practice
of your choice and
no record will
be created.
Yes
•
Following the Public Information Programme,
where a patient has decided that they want an
SCR and have not opted out, a record was
created containing a GP summary with the
patient’s core clinical details of medication,
allergies and adverse reactions.
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Yes (additional information)
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•
Once a patient has an SCR, additional
information can be added to the SCR. This is
only with the explicit consent of the patient
A discussion will take place between the patient
and the practice before any additional
information is added
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No (patient informs GP Practice)
•
•
Patient has decided they do NOT want an SCR
to be created and has returned an opt out form
to their practice
A patient can change their mind at any time
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Recording SCR
Consent
Recording Consent
Consent preferences can be recorded in two ways:
1. By adding the relevant code manually to a
patient’s record
2. By using the GP practice systems’ SCR
consent management screens
In each case, only the latest value will be referenced
to control the flow of information to the SCR
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Codes for patient preferences
SCR Patient Consent
Preference
CTV3 Read Code Term Effect on content of
SCR
code Code
Implied consent for medication, XaXbX 9Ndl
allergies, and adverse reactions
only
Implied consent The SCR will ONLY
for core SCR
contain: medication,
dataset upload allergies and adverse
reactions
Express consent for medication, XaXbY 9Ndm
allergies, and adverse reactions
only
Express
consent for core
SCR dataset
upload
The SCR will ONLY
contain: medication,
allergies and adverse
reactions
Express consent for medication, XaXbZ 9Ndn
allergies, adverse reactions,
and additional information
Express
consent for core
and additional
SCR dataset
upload
The SCR will contain;
medication, allergies and
adverse reactions plus
any additional information
Express dissent (opted out) Patient does not want a
Summary Care Record
Express dissent No SCR exists
for SCR dataset
upload
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XaXj6 9Ndo
Security of the SCR
Security of the SCR
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•
In order to maintain the security of the SCR
security measures are in place to control access
These can be grouped into three categories:
1. Technology – controls embedded in the systems
2. Organisational – controls embedded in the NHS
3. Individual user – appropriate staff conduct
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Technology Security Measures
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Secure NHS Network (N3)
Smartcards - are needed to view and update
SCRs
Role Based Access Controls (RBAC) - ensures
that only appropriate staff can view and create
records
Legitimate Relationships – ensure that only
healthcare staff involved in the patient’s care can
view their record
Permission to View - gives patients control of
access to their record at the point of care
Every action that a user takes is audited
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Organisational Security Measures
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Legislation e.g. Data Protection Act
Caldicott Principles
Care Record Guarantee
Local Information Governance policies and
procedures
Contractual measures e.g. confidentiality
clauses in employment contracts
Training
Existing organisational security
measures apply to the access of SCRs
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Individual user based Security
Measures
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Adherence to Smartcard usage policy
Existence of legitimate relationships
Asking for permission to view (where applicable)
NHS duty to patient confidentiality
Professional codes of conduct
Contractual requirements
Adherence to organisational security measures
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Security Measures
Organisational
measures
Contracts
Policies
Procedures
Legislation
Training
Technology
measures
Legitimate Relationships
Permission to View
RBAC
Smartcards
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Individual
behaviours
Smartcard Usage
Confidentiality
Professional standards
Contracts
Permission to View
Policies
Creating an SCR
When will my Practice start
creating SCRs?
A Practice will only start creating SCRs (go live)
when:
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There is agreement between the Practice and the
Health Organisation to take part
Once the practice and the Health Organisation
agree that patients have been adequately
informed about the process and properly enabled
to opt out should they wish
They have a GP system that is compliant with
SCR
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What happens before we go live?
Within your Health Organisation there should be an
SCR lead who will work with your site to ensure:
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All of the appropriate technical checks are carried out
All of the staff within the practice are trained
All of the staff within the practice have received the
information to enable them to deal with any queries
patients may have about SCR
All staff are compliant with local best practice e.g. Patient
Demographic (PDS) information management
The appropriate data quality standard is reached
The new patient process is operational
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What happens when we go live?
• There will be an “initial upload” of the three key core
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data items (allergies, adverse reactions & current
medications) for each eligible patient who has not
opted out of having an SCR
This is a one off event
How this upload happens is different but in all
circumstances:
• The upload will be scheduled at a time
convenient for the practice
• You will be consulted about all activities being
carried out at the site and who will be
undertaking them
• You will be supported by your system supplier
and/or Health Organisation
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What happens after we go live?
• Staff must follow all of the processes that were
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explained during the training e.g. using smartcards
If staff believe that the system is not working as it
should be then they should follow normal escalation
processes
Always ensure that there are patient packs with opt
outs, on site to give to patients that register with the
practice
Should practice staff receive a query that they
cannot answer they should contact the Health
Organisation
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How are SCRs updated?
After the initial upload, SCRs are updated every time:
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a change is made to the core data set
an additional data item is marked to be included or
excluded from the patient’s SCR e.g. a diagnosis (This
only results in an SCR update if the patient is set to
explicit consent)
Updates are only made if the user is authenticated with
their smartcard and the patient’s local demographic
details are matched to the PDS
The SCR is date and time stamped so that anyone viewing
the SCR knows the date and time it was last updated
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Creating the Record:
Do you want a Summary Care Record?
YES
NO
Do nothing and a
record will be
created for you.
Inform your GP Practice
of your choice and
no record will
be created.
Viewing the Record:
Can I/we look at your Summary Care Record?
When you present for
care, you will be
asked* if your
record can
be viewed.
*In an emergency where you are unable to be asked, or certain medical/legal circumstances (such as Court Order)
the clinicians involved in your care may access the record without asking. All such actions will be recorded for investigation.
Yes
•
Following the Public Information Programme,
where a patient has decided that they want an
SCR and have not opted out, a record will be
created containing a GP summary with the
patient’s core clinical details of medication,
allergies and adverse reactions.
Home
Yes (additional information)
•
•
Once a patient has an SCR, additional
information can be added to the SCR only with
the explicit consent of the patient
A discussion will take place between the patient
and the practice before any additional
information is added
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No (patient informs GP Practice)
•
•
Patient has decided they do NOT want an SCR
to be created and has returned an opt out form
to their practice
A patient can change their mind at any time
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Practice Activities
Practice Activities
The following activities need to be considered when
implementing the SCR:
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Nominating a Practice Expert
Managing Data Quality
Managing PDS Information
Consistent use of Smartcards
Managing Patients Preferences
Supporting Children & Vulnerable Adults
Viewing SCR for Temporary Resident Patients
Dealing with SCR Deletion Requests
New Patient Registration
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Nominating a Practice Expert
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Some practices have found benefit in having a
member of staff who acts as an SCR expert
and/or a single point of contact. This means that
they can deal with:
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Difficult or complex queries
Discuss GP Summary content
Support other practice staff
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Managing Data Quality
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National SCR Data Quality Standards exist to
ensure that GP practices have reached a
minimum data quality standard before going live
with SCR
The implementation of these data quality
standards are managed locally by the Health
Organisation
Your Health Organisation will be able to advise
what is required to meet and maintain those
standards
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Managing PDS Information
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Patient demographic information held by the GP
IT system must match that held in the Patient
Demographic Service (PDS) for SCRs to be
updated
This is known as PDS synchronisation
Where discrepancies exist, they need to be
resolved to enable clinical information to be sent
to the SCR
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Consistent use of Smartcards
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A Smartcard is required to:
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Trigger the initial upload
Maintain/send any updates to existing SCRs
When a user of a GP IT System is not logged on
with a valid Smartcard, the GP system will not be
able to connect to the spine, update the PDS or
SCR
A process is required to ensure that patient
records accessed by staff who don’t have a
Smartcard (e.g. new starters or locums) are then
updated and sent to the SCR
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Supporting Children & Vulnerable Adults
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Children DO get an SCR but do not get a letter
Children and vulnerable adults can be opted out
Guidance and legislation exists to support GPs
decision making regarding supporting children
and patients who may lack capacity
For children this may include assessing their
competence (known as Gillick competence) and
considering their best interests
For adults who may lack capacity, the Mental
Capacity Act should be referenced
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Viewing SCR for Temporary Resident
Patients
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A practice may feel that there is benefit in viewing
SCR to support clinical care for patients that are
temporarily registered with the practice
Your Health Organisation will be able to assist if
this is required
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Dealing with SCR Deletion Requests
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Once a record has been created it is possible for
a patient to request that it is deleted
Patients should contact their GP practice if they
wish to request that their record is deleted
The practice should contact the Health
Organisation with this request
An investigation then takes place to see if the
SCR has been used
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•
If the record has not been used it can be deleted
If the record has been used it cannot be deleted
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New Patient Registration
Upon joining a new practice a patient should be
given the option of opting out of the SCR. The
practice should:
• Record the patients consent preference
• Check the existing Live SCR during the summarizing
process
• Enter any relevant information from the Live SCR onto
the Local summary. Ensuring a record with additional
information is not superseded with a core only record
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Viewing an SCR
Permission to View
Can I/we look at your Summary Care Record?
When you present for
care, you will be asked
if your
record can
be viewed.
Viewing an SCR
•
•
The SCR can be viewed by authorised healthcare
staff in urgent and emergency care settings
In order to a view an SCR, a clinician must:
– Use an NHS computer
– Use their NHS Smartcard with their passcode
– Have the appropriate Role Based Access
Control (RBAC)
– Have a legitimate relationship with a patient
– Ask a patient for their permission to view their
record
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Permission to View Principles
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Patients are asked every time their record is
accessed
Designed to allow a flexible approach to asking
permission e.g. clinicians or administrative staff
may request permission individually or on behalf
of a clinical team
If a patient is unable to grant permission to view
e.g. they are unconscious, a clinician can use
emergency access to view the SCR if they
believe it to be in the patient’s best interests
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Viewing an SCR
An SCR can be viewed in the following ways:
1. Summary Care Record Application (SCRa) –
a stand alone web based application
2. Through integration with their existing clinical
system, for example the Adastra Out of
hours system, Emis Web GP Software, TPP
GP software
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Viewing the SCR
May we view
your SCR?
YES
NO
Healthcare
Emergency
staff Care
With the patient’s permission to
view the healthcare
staff member
SUMMARY
will be able toCARE
viewRECORD
the contents of
If a patient says NO their SCR
the SCR
should not be accessed
Patient
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How the SCR
looks…
Core Information in an SCR
Time and date is
clearly visible
indicating when the
GP Practice last
shared this summary
Medications,
allergies and
adverse
reactions
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Additional information in an SCR
Additional
information
added
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What does it look like if the patient
is no longer registered?
• When a patient leaves (deregisters) from their GP
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•
practice, a note is added to their SCR to indicate
that the patient left the practice
This disclaimer is added to the banner at the top of
the SCR stating that the practice no longer has the
responsibility for that patient
Below is an example of the note that is added to the
bottom of the SCR:
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Summary of Activities
Let your GP Practice know your
decision to opt out (mail back the
opt
freepost)
Don’t
doform
anything
and and
one they
will will
Your
name out
Address
opt
you outfor
in their
Address
be created
you! system,
Postcode
ensuring an SCR is not created for
you.
Following the end of the Public
Information Programme…
The creation of SCRs will only take place
when a practice and their Health
Organisation agree that patients have
NoYes
- I don’t
– I want
want
aI’ve
aWhat
Decision
should
made
considered
I do?
my options.
been informed
andallenabled
toRecord
opt
out
Summary
Care
Practice meets
Data
Quality
andshould
Technical requirements
and
they wish.
SCR CREATION
HO
Authorised to ‘Go Live’
FP69
GP Practice
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Patient
Summary - SCR
Your name
Address
Address
Postcode
Permission
to View
granted
Patient
GP Summary Update
Containing:
GP Summary Update
Containing:
•Core Data or
•Core Data or
•Core Data &
Additional Information
•Core Data &
Additional Information
GP Practice
Min 12 weeks to
decide
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Emergency Care
Further Information
More Information
•
GP Practice Support
http://systems.hscic.gov.uk/scr/staff/gppracinfo
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Data Quality
http://systems.hscic.gov.uk/scr/staff/impguidpm/dq
•
Frequently Asked Questions
http://systems.hscic.gov.uk/scr/staff/gppracinfo
•
SCR Main Site
http://systems.hscic.gov.uk/scr
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