sharing

Record Sharing on SystmOne

Explicit consent is now required for sharing any patient identifiable data for direct patient care.

This is inline with the recent ICO notifications and the forthcoming European Data Protection Regulation. For further information about data sharing agreements, please see here.

The following resources will help SystmOne practices in the process of gaining consent from your patients.

It is recommended that high risk patient groups are targeted initially as a priority. This may include patients on end of life registers, admission avoidance registers, frailty registers and safeguarding registers.

Other patients should then be targeted opportunistically. This may be during a new patient registration or when a referral is made. A Wiltshire CCG LES is being explored to potentially provide funding to help target the remainder of our practice populations to gather explicit patient consents.

Please note:
Implied consent to share the patient record is no longer acceptable, automatic sharing ‘out’ and ‘in’ should be disabled on SystmOne.
To do this, go to Setup > Users & Policy > Organisation Preferences > Clinical Policy > Sharing.
Then ensure both boxes are unticked for automatically recording preferences for sharing out and in.
This will only affect patients prospectively and will not retrospectively change any historical sharing preferences.

Resources

Summary Care Record    >

The Summary Care Record contains basic information including patient contact details, NHS number, medications and allergies. This can be viewed by GP practices, Hospitals and the Emergency Services. If patients do not want a  Summary Care Record, they can complete the appropriate opt out form.

The Summary Care Record with Additional Information can be added to create an Enhanced Summary Care Record. This can include specific read codes and care plans which will help ensure that the patient receives the appropriate care in the future. Patients must consent to enable this.

For SystmOne Users: To view & update a patient’s sharing preferences, just click the hand icon under the patient’s name. This will open the Ardens template where the SCR consent can be recorded.

SystmOne Record Sharing    >

The Electronic Data Sharing Model (EDSM) is the SystmOne record sharing mechanism for sharing patient records between different healthcare organisations who use SystmOne. This includes for example GP practices, OOH, Community Services & Hospices. To ensure effective patient care occurs, it is essential record sharing is recorded.

The EDSM involves:
‘Sharing Out’ which enables a patient’s record to be viewed by another organisation.
‘Sharing In’ which enables their record to then be viewed from another organisation ‘

A common misunderstanding is that if you select ‘Sharing Out’, other organisations will be able to view your patient records. You are however only enabling your patient’s record to be viewed and other organisations can only view their record if they gain explicit patient consent.

To view & update a patient’s sharing preferences, just click the hand icon under the patient’s name. This will open the Ardens template where EDSM sharing preferences can be made, including other sharing preferences for the SCR and other 3rd parties too.

1. Sharing Out
What to say to patients:
“Do you consent to your GP health record being made available to other services that care for you?”

Options:

1.1 Sharing out consent: YES
If consent is given, other care services will still have to gain the patient’s explicit consent to view their record. If it is an emergency situation, other organisation may override their consent and a privacy notice is automatically sent to your surgery which is fully auditable. Even if a patient has ‘shared out’ you can still mark individual events as private, click here for further information.

1.2 Sharing out consent: NO – except in an emergency
This is where Sharing Out dissent or No Preference is recorded but this can be overriden in an emergency by another organisation. This other organisation must give reasons for overriding the consent and a privacy notice is automatically sent to your surgery which is fully auditable.

1.3 Sharing out consent: NO – even in an emergency
This is where Sharing Out Dissent occurs and the ‘Prevent this record being accessed by Sharing Override’ is ticked. No matter what the situation, no other organisation will be able to view the patient’s record. Please consider the consequences that this may have in an emergency before doing this.

1.4 Sharing out consent: NOT ASKED
If a patient does not have mental capacity to consent, the record can be shared by ticking ‘Consent not asked’ and ‘Mental capacity’. A reason must also be added.

2. Sharing in
What to say to patients:
‘Do you consent to your GP Practice viewing your health record from other services that care for you?’

Options:

2.1 Sharing in consent: GIVEN
This means that if the patient has shared our their record from another organisation, you will now be able to see this.

2.2 Sharing in consent: REFUSED
This means that you will not be able to see any information that is recorded at a different organisation.

2.3 Sharing in consent: NOT ASKED
If a patient does not have mental capacity to consent, the record can be shared by ticking ‘Consent not asked’ and ‘Mental capacity’. A reason must also be added.

Patient infomation    >

In accordance with fair processing requirements, it is essential that patients are informed in an appropriate manner about the consent process.  The following resources can be used to assist Practices with this, so that patients are informed about the record sharing process and have the appropriate information to make an informed decision.

1. Posters for your waiting room
2. Leaflets for your waiting room – see here
3. On your surgery website – Please feel free to create a link to here
4. On your surgery TV screen
5. Message on prescriptions
6. Email and SMS to patients (please note posting information is not required)

Please also consider discussing this at your PPG meetings.

FAQs

What is the problem with ‘sharing’ on TPP?

The current sharing model in TPP enables a GP practice to ‘share out’ the TPP record to make it available to other health care providers.  Those other health care providers must ask for the patients explicit consent before accesing the record thus putting the patient in control of who sees their own record.  It was on this basis that Wiltshire CCG encouraged practices to share out the patient record at practice level on the basis of ‘implied consent’.  However, it has become clear that TPP does not allow the sharing out option to be limited to specific health care providers or providers within a certain geographical area – this leads to a ‘share all’ or ‘share nothing’ situation (allowing in theory a patient record to be accessed by any organisation anywhere in the country with access to TPP).  This had led to questions by the ICO, NHS Digital and the BMA over the validity of this sharing model and whether it potentially breaches the DPA.

As a result it has now been made clear that patients need to be fully informed of how their record is being shared and that they must give explicit consent for this to occur.

Why has this become an issue now?

The ICO and NHS Digital have been in discussion for some time regarding the sharing model with TPP.  However more recently there have been several articles in both the medical and national press which have pushed the issue up the agenda.  As a result, numerous Wiltshire practices are reporting that patients are contacting them for reassurance or to insist their notes are not shared.  However these decisions are often based on incomplete or inaccurate information.

So, should we turn off sharing and what happens if I turn off sharing?

Turning off all sharing in TPP effectively means that none of your patient records will be available to other health care organisations. Even where a patient wishes to share their record they will be unable to do so.

The current model of care across Wiltshire relies heavily on the sharing of records within TPP to provide safe, effective and efficient healthcare.  TPP and its sharing model is currently being utilised to enhance the level of  care in, amongst other areas;  GP surgeries, OOH services, palliative care/hospices, community services, leg ulcer clinics, community heart failure services and in the three acute Trusts across the county.

Wiltshire CCG strongly recommends that sharing is not turned off as this may have a significant and detrimental effect on patient care.

What should practices do now?

Whilst the ICO has been clear that turning off sharing is not necessary, it has been equally clear that doing nothing is not an option either.

Practices must therefore be taking active steps to:

  • Ensure all patients are fully informed about how their records are shared and,
  • Document explicit consent from patients regarding their sharing preferences.

Wiltshire CCG has released detailed guidance regarding the next steps practices should be taking to achieve these aims (http://www.wiltshireccg.nhs.uk/gp/gpedsm).

How can a practice ‘fully inform’ its patients regarding how their record is shared?

As things stand, the ICO is not expecting practices to write to every patient to fulfil requirements to fully inform them, but is expecting all other opportunities for fair informing to be utilised.  Wiltshire CCG will be providing materials to aid you in this respect but your approach could include:

  • displaying posters in your waiting rooms;
  • notices on your websites and other on-line services;
  • leaflets placed in waiting rooms;
  • advice on repeat prescription messages;
  • advice during consultations;
  • text (SMS) notices;
  • advising your Patient Participation Group (PPG)

How do I explain the sharing options to patients?

Sharing out:  “Would you like me to enable your records to be shared with other health care providers? These other providers will still have to gain your explicit consent to view your record but will then benefit by having access to your medical record to ensure they give you the best possible healthcare tailored to you. If it is an emergency situation and you cannot give consent, this can be overridden so that they can see your record, but we are informed of this and it is fully audited for everyone to see.”

Sharing in:  “Would you like me to be able to view your shared record from other health care providers?”

If we inform patients by mail and do not hear back from them can we assume they are consenting?

No.  This is still implied consent.  Whilst it is vital to provide patients with all the information they need to make an informed decision, only their explicit consent verbally or in writing is sufficient.

How can I reassure patients that their data is safe?

All NHS organisations have a robust approach to Information Governance where the confidentiality of patient data is key.  Any professional breaching the DPA puts their professional registration at risk.  TPP has recently introduced new restrictions so that any new user of TPP must first satisfy stringent IG requirements before being allowed to share out or share in records.  There is a fully auditable trail of who is accessing records, when they have been accessed and where they have been accessed from. You can also reassure patients that the practice is sent a notification if ever their consent is overridden to access their notes

A patient wants to know who has accessed their notes – how do I show them?

Patients with access to SystmOne online will now be able to review who has accessed their record simply by logging in. They will soon also be able to see their sharing preferences in the online view.   For patients without online access, a member of the practice team can easily access this information through the Administrative tab of the patient record.  You can also reassure patients that the practice is sent a notification if ever their consent is overridden to access their notes

Where can I find further information and guidance?

The BMA have released guidance including their own FAQs (some information from which is included in this document) which can be accessed here: https://www.bma.org.uk/advice/employment/gp-practices/service-provision/ttp-systmone-faqs

…………….