GPGv4

http://www.rcgp.org.uk/get_involved/informatics_group.aspx

SCIMP Nov 2010

GPGv4• The Good Practice Guidelines for GP electronic

patient records v4 (2010)– A review in 2009 concluded there was still a need for

professionally owned, authoritative guidance to update and replace the Good Practice Guidelines for GP electronic patient records v3.1

– The new GPG would act as a reference source of information for all those involved in developing, deploying and using general practice IT systems.

– GPGv4 would also need to maintain and update the link between earlier versions of the GPG and the GMS & PMS regulations.

Scope & definition

• Need for a complete re-write of the guidelines to include all the existing sections, and extend the scope to include new services (e.g. SCR, EPS & GP2GP messaging).

• Need to develop new guidance in areas such as high quality clinical records and data quality to facilitate records sharing, inter-operability and communication.

Content1. Strategic Context for the GPGv42. The Purposes of Health Records3. Clinical Safety Assurance4. Records Governance5. Shared Record Issues6. High Quality Health Records7. Clinical Coding Schemes8. Data Transfer & Interoperability

a. The Personal Demographic Serviceb. GP2GP Electronic Record Transferc. Data Migrationd. Clinical Messaginge. The Summary Care Record (England) and Emergency Care Summary (Scotland)f. High Quality Medication Records & The Electronic Prescription Service

9. Towards Paperless Practice10. Attached Electronic Documents 11. Working in an e-business Environment12. Education and Training

For information• Consent & sharing

– Overall, the guidance from professional regulatory and representative bodies clearly supports the sharing of appropriate health information between health professionals for the process of clinical care and audit. However, there is also a consistent emphasis on obtaining appropriate consent and informing patients how their health data may be used.

– SRPG report– Patient access report– http://www.rcgp.org.uk/get_involved/informatics_group.aspx

• Records retention & audit trails– No exceptions to DPA– BUT patient record and audit trail MUST be retained by the practice even

after a patient de-registers– No subsequent access to record except for necessary purposes– Such accesses should be audit-trailed

Data Quality• Issues in shared records– Medical data has a marked degree of inherent

variability, uncertainty and inaccuracy – It is generally accepted that information derives an

important part of its meaning from the context in which it is recorded

– CARAT model?• Completeness • Accuracy • Relevance• Accessibility • Timeliness

Data Quality• Lessons so far;– Must understand the various purposes for which

those records will be used and the factors that contribute to make the records fit for purpose.

– The care and skill of the record keeper and the capabilities of the particular clinical system being used, contribute to the quality of the record

– Record keeping polices and user training should be designed to make the best of the system being used

– Essential to understand that assuring and maintaining data and record quality is an ongoing process, requiring active audit and intervention

Data Quality

• Finally;– It is through the use of clinical information that its

quality will become apparent. Practices, PCOs (and their successors), should ensure that mechanisms are in place to ensure that insights into record quality, emerging from use are applied to its continuous improvement.

– User group experience?• TPP…• Emis Web…

Issues - 1• GP regulations– The future of paperless accreditation. In the event that

there is no change, we will carry the content from GPGv3.1 forward with some minor updating changes only.

– The GPGv4 team need to know if there will be any consolidation of the current “accreditations” into a single process (paperless practice, NHS net connectivity & IG toolkit)

– DH needs to ensure that the appropriate changes are made in the regulations to mandate GPGv4 when it is published later this year

– DH should consider making computer records the default (rather than paper) in any future version of the GP Contract

Issues - 2

• Information governance– The profession require resolution and clarity on

the issue of who is the data controller in shared records (e.g. TPP SystmOne & Lorenzo);

– Is it different for Emis Web?– and the implications for GPs who may take

responsibility for the accuracy of records created by other health professionals in other settings

– (under discussion)

Issues - 3• GP2GP – for JGPITC…– JGPITC believe that where implemented GP2GP transfer

should be the preferred (& default) way of transferring GP records and that we should as far as is practicable move away from transferring patient records in the clear on paper or other media

– JGPITC wishes to see an end to the general requirement that ‘sending’ practices must print out the EPR and file attachments after the patient record has been transferred by GP2GP.

– The JGPITC must first define a clear requirement that takes account of clinical safety and then work with the GP2GP Project Board and others to develop and implement a solution

Issues - 4

• PDS - Trace & sync issues, data quality• Data migration – links to DQ• SCR – scope & content• Coding complexity– RV2, CTV3, S-CT

• 4 nations…• English white paper – impact & implications

And finally….

• Please help!• Read the GPGv4 draft• Comments welcome – Via SCIMP– To me directly alan.hassey@nhs.net

• By 14th November…