Introduction to the Summary Care Record (SCR)

1. Introduction to theSummary Care Record (SCR) Viewing Concepts Module GP Sites Viewing Concepts Module – GP v2.01 14-05-09

2. Contents Introduction Background SCRViewing ViewingScenarios FurtherInformation

3. Introduction

4. Introduction This SCR viewing module: • is intended to build on information previously covered in the core module • is an overview of the concepts involved in a viewing implementation in GP practice • is aimed at staff who plan to view SCRs and staff involved in implementing SCR viewing Home

5. What is the SCR? • The SCR is: • An electronic patient summary containing key clinical information • Accessible by authorised healthcare staff treating patients in urgent and emergency care settings • Optional – patients can choose to have or not have an SCR • Accessible only with the patient’s permission (except in exceptional circumstances e.g. if the patient is unconscious or incapable of giving permission) Home

6. Key facts for users viewing SCRs • The SCR: • Contains essential information from the GP record: medications, allergies and adverse reactions • May contain additional clinical information from the GP record such as significant diagnoses or care plans if the patient has given their explicit consent • Is updated whenever that information is updated in the GP system • Supports existing clinical processes for temporary residents • Is time and date stamped to inform the user when it was last updated Home

7. How the information is displayed in SCRa Information derived from GP record Time and date is clearly visible indicating when the SCR was last updated by the GP Practice Core information of medication, allergies and adverse reactions Home

8. Context of the data within the SCR • Users should be reminded that SCR is a summary and not a full detailed care record for the patient • The SCR may not contain all information for a patient e.g. medications prescribed outside of the GP Practice • Information held within the SCR is a summary of the information from a patient’s GP practice at the time it was created. This is indicated by the date and time stamp on the SCR. • Users should therefore check for subsequent information as part of their normal history taking Home

9. SCR Core Concepts - Recap Permission to view granted Your name Address Address Postcode • GP Summary Update • Containing: • Core information or • Core & • Additional Information • GP Summary Update • Containing: • Core information or • Core & • Additional Information Urgent and Emergency Care GP Practice Min 12 weeks to decide Patient Home

10. Background

11. 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 Home

12. How can you benefit from viewing SCRs? The SCR is a tool available for you to use when you require additional information or clarification about a temporary resident / non-regular patient. Home

13. Where else can SCRs be viewed? The SCR is primarily viewed in cases of urgent and unscheduledcare. For example: • GP out of hours services • Walk in centres and minor injury units • Hospitals e.g. Emergency Departments, Acute Assessment Units, Hospital Pharmacy • Mental health crisis services • Ambulance services Other health care settings have also found value from the use of SCR Home

14. How to view SCRs Various IT systems are currently available through which SCRs can be viewed: • SCR Application (SCRa 2) – a stand alone web application that can be used in any care setting with N3 connection e.g. Out of Hours • Integrated GP Software – TPP, EMIS and INPS all have SCR viewing capability integrated within the application. Allowing practices a simple way of accessing the information contained in SCR. Home

15. Steps to Viewing the SCR In order to view the clinical information in the SCR, healthcare staff need to: • Use a smartcard with the correct role • Identify and locate the correct patient • Have the patient’s permission to view • Have a legitimate relationship (LR) with the patient, i.e. be directly involved in their care Home

16. Viewing the SCR May we view your SCR? YES NO Doctor With the patient’s permission, the healthcare staff can view the contents of the SCR SUMMARY CARE RECORD If a patient says NO their SCR should not be accessed Urgent or Emergency Care Legitimate Relationship Patient Home

17. SCR Viewing

18. SCR Viewing Controls There are various system and behavioural controls in place to ensure only authorised healthcare staff can view SCRs. These include the following which will be explained in this section: • NHS smartcards • Role Based access controls (RBAC) • Permission to view • Legitimate relationships – a mechanism to ensure healthcare staff are directly involved in the patient’s care • Alerts and auditing controls Home

19. To access SCRs, an NHS smartcard is required • Logging on with a smartcard uses two factor authentication, i.e. something you have (the card) and something you know (pass code) • NHS staff will also need to have specific RBAC added to their cards in order to access any patient identifiable information. NHS Smartcards 999456789101 A. N Doctor Home

20. Role Based Access Controls RBAC determine how much information a user has access to. For example: • An administrator/receptionist in a practice can register the temporary patient on the system and obtain their demographic information to confirm identity as now. Their RBAC will therefore only allow them to access this specific information and no clinical information. • A GP receives a temporary resident in their room and asks for permission to view the SCR if required for that consultation. Therefore, their RBAC will allow them to access both sets of information. Home

21. Permission to View - Overview • Patients will be asked their permission before their record is viewed • Where permission to view cannot be obtained, for example if the patient is unconscious or incapable, the SCR can be viewed in the patients’ best interests. This is called emergency access. This would be highly unlikely in a practice • Emergency accesses generate alerts to allow an organisation to monitor the use of this option and ensure it is being used appropriately Home

22. Permission to View - Examples There is flexibility in how an organisation can implement permission to view. For example: • A Practice could get the receptionist to obtain PTV with every temporary resident that enters the practice. • A practice may leave the GP to ask for PTV on a case by case basis Home

23. Legitimate Relationships • To view any patient’s medical information (including paper records), healthcare staff need to be involved in their care, i.e. have a legitimate reason • Legitimate relationships are technical controls to ensure SCRs can only be viewed by those staff involved in the patient’s care • Legitimate Relationships (LR’s) are automated within the different viewing software's both in GP practice and elsewhere Home

24. Legitimate Relationship Examples • When a patient is registered at a practice, the receptionist confirms the attendance and the LR on behalf of the clinical members of that practice e.g. doctors, nurses, other AHP’s etc. • During the night, an acute assessment unit may not have a ward clerk on duty who could confirm the patient attendance. Therefore, the clinicians would have to self claim their LR (this would trigger an alert that would be investigated by the Privacy Officer) Home

25. SCR Viewing Controls Organisational measures NHS contracts NHS policies NHS procedures Legislation Training Technological measures NHS smartcards RBAC Legitimate relationships Permission to view Individual behaviours Smartcard usage Codes of confidentiality Professional standards Contractual obligations Permission to view NHS policies Home

26. Viewing Scenarios

27. Viewing the SCR • This scenario does not cover every situation that may arise but is representative of the majority of cases. • The appropriate arrangement for your organisation will be discussed with you as part of your local SCR implementation project • When the surgery is using an integrated SCR viewer then some controls are managed by the system Home

28. Scenario • A temporary resident arrives at a practice • The receptionist registers the patient (this confirms a legitimate relationship) on arrival at the practice. • The Doctor assesses the patient and asks for their permission to view their SCR. Home

29. GP Surgery May I view your SCR? Doctor The clinician asks to view the content of the patient’s SCR for themselves YES SUMMARY CARE RECORD Receptionist Legitimate Relationship Temporary Patient Home

30. Alert and Audit Controls • Audit trails exist for every SCR access and viewing activities are linked to the user’s smartcard. • Alerts are also generated to allow an organisation to monitor the use of SCR viewing controls and ensure all accesses are appropriate. • Together, they provide a means of tracing SCR viewing activity and safeguarding patient information. • Each organisation must ensure that they have a Privacy Officer to manage alerts and monitor SCR viewing activity. Home

31. Sample Business Processes for Privacy Officers • Business processes are needed for the Privacy Officer to define how to investigate alerts • The following activities need to included in these processes: • Receiving notifications or running reports • Investigating alerts • Escalating inappropriate accesses to relevant parties • Closing alerts Home

32. End to End Processes • Users view SCRs by: • Creating a Legitimate Relationship (LR) • Requesting Permission to View (PTV) • Alert generated when: • LR self claimed • Emergency Access is claimed • Privacy Officer investigates and manages alerts • Privacy Officer can audit viewing activity Home

33. Further Information

34. Useful Links SCR Training Page: http://systems.hscic.gov.uk/scr/staff/impguidpm/training Viewing SCRs – implementation guidance: http://systems.hscic.gov.uk/scr/staff/impguidpm/dq General information on SCR: http://systems.hscic.gov.uk/scr Home