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back to article Health records riddled with errors

The Summary Care Records scheme is not trusted by doctors because some records have serious errors. No patients have actually been harmed, but only because doctors do not trust the information contained in the database and so are double-checking information. Researchers from University College London found records which had …

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Hmmmmmmm

So docs dont trust the summary care records because they contain errors...... Having actually had to do work based on patient records I can suggest it is perhaps because certain doctors arent filling in certain aspects of the records or filling them in correctly????

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FAIL

Well, yes ...

but that's largely the problem with all databases. Thus should we really 'trust' these uber databases if they are going to have so many errors? I've opted out of the thing for precisely this reason.

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What is the secret?

In all of the world - at least the parts of the world that can plug in a computer and get it to boot - I doubt there's another country that can so consistently turn government IT projects into tragi-comedy so consistently.

What is the secret? What is it about Britain that, whenever the phrase 'multi-billion pound government IT project' is uttered everyone knows that it's going to turn into yet another embarassing cock-up?

If anyone out there knows, please say because we may be able to use it as some kind of cyber weapon.

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BT *shudder*

I sent my opt-out letter this morning to be removed from the database, I wanted out because I heard BT are involved, and the governments track record on data security is laughable.

This story should be the nail in the coffin, opt-out before you end up in one.

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I wish...

...I could say I was surprised, but I'm not in the least. I don't know what's been happening on the project over the last few years, but during the couple of years that I worked on part of this monumental cockup in the early days, there was never enough time to test anything properly (if at all). Usually because some bigwig in senior management, the Department of Health or the Government had declared that some bit of functionality or other would be available by some particular date, regardless of whether or not it could actually be achieved (political goals and point-scoring trumping everything else).

Add to that the usual IT industry mix of inadequate requirements, myopic design decisions and poor project management at several levels and it's a wonder that any bit of the system actually works at all, much less does the right thing or, indeed, anything.

That's not to say that there weren't some decent designers, good engineers, capable project managers, etc. all busting a gut trying to make some kind of faux-silk purse out of this particular sow's ear. It's just that they were usually outnumbered, and sometimes outranked, by the hordes of inexperienced and incompetent numpties who had been recruited by a senior management that largely consisted of utter idiots. Or, as it's commonly called in Government IT project circles, business as usual.

Remember to contact your GP and opt out. You'll probably be safer that way.

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My Experience

Well I worked on the data migration for several of the LSPs, and I can tell you that we migrated what was available, with very strict Audit and Reconciliation requirements to prove it.

My feeling on this is very much GIGO. Some of the source data from the creaking legacy systems and hodge podge of access databases, spreadsheets and hacked together "data warehouses" - had to be seen to be believed.

In one case I was dragged in front of one of the senior hospital administrators as they were missing certain aspects of discharge details after the migration. We looked and looked, double checked the audits, but couldn't find it. So going back to basics, I asked them to show me where on the system they thought they held this data so I could trace it from their side. Lo and behold I was taken into the admin office and shown all the hand written post-it notes stapled onto paper files containing the data. After two hours, I still hadn't convinced them why we didn't have that data.

Do I trust the SCR? Possibly, but I trust it far more than the local grown systems and processes that are maintained at the moment.

Anon to protect the guilty.

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Report

"Hat tip to Computer Weekly which got its hands on the report."

Makes a nice change. I've usually read everything CW has to say right here on El Reg with far better use of English and a day earlier.

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crap medical databases

I worked for nearly a year in a GP's surgery transferring paper medical records to the EMIS database which was to replace them. I was conscientious and tried to be as accurate as possible but I had no medical training, no support from medically trained staff and the database was beyond useless. The former are important because of the latter - EMIS would (as far as I was aware) only allow input of medical conditions contained in the database with little room for additional explanation, clarification or subtlety that might exist in the paper records. If a condition did not exist on the database (as was very often the case) I would have to find the closest match and make do. I am sure there were many errors in the records I transferred. The only saving grace was that the GP's didn't bother to use the EMIS system anyway (I believe it may have been scrapped in any case), found it useless for the same reasons I did and carried on using the old paper notes regardless of official coercion. Because of doctors' scepticism I doubt anyone would have come to grief through inaccurate records, but at best the whole thing was a massive waste of time and money.

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Bad labels

From my own experience, different parts of the NHS system don't even use the same jargon. A few years ago, my mother was discharged from hospital, and I had the chance to see the summary. It was a mass of TLAs. I found some sources on the web, and the different professional medical bodies were listing different TLAs for, apparently, the same thing.

(I am, incidentally, waiting for my mother to be discharged from hospital. A reliable way of getting info out of the GPs practice would be a good thing. It's possible that the letter from the GP (a miracle getting a visit, I think) to the Hospital went missing somewhere in the chain.)

I'm sure we can all see ways in which IT could improve things. They're still using fax machines, and lack even the message-tracking possible with RFC 1149.

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Anonymous Coward

innacuracies

How could that possibly happen when you have high quality staff* transcribing meticulous** paper records with the highest possible degree of oversight***

From the horror stories i get told by my parents, you're lucky anyone can tie what they're doing then and there back to you, nevermind a history.

*either offshored to a non-native english speaking country, or given to minimum wage 'temps'

**barely ledgible scrawl, crumpled, torn, stained with coffee, etc. With seemingly random identifers.

***any innacuracies in the sample checks, are easily fudged, as it makes those accuracy statistics look good

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Yeah but ...

They'll just tout a 98% or 99% accuracy rate as an amazing success and give each other

pats on the back and bonuses in the pay packets.

The fact that the 1% or 2% inaccurate represent thousands, if not hundreds of thousands of

poor folk whose medical records will be forever dog food will go by the wayside.

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Nails, who needs nails for this coffin.

It's already knee deep in a concrete over coat.

99% means 1% failure. 60 milion in the UK, so 10 % is 6 million, and 1% is 600,000. So roughly the size of West yorkshire worth of errors then?

Records only work if they fill them in, if you don't pay, they won't fill them. We have to pay £1.55 for each patient that is referred to breast cancer screening. If we don't pay, they don't refer and record details of referral. Details are six boxes in an excel spreadsheet. Hardly time consuming.

You think they will fill in summary care records for free based on that logic.

Anon as you know where I work.

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Presumably...

...we are all supposed to register for online access and check our own records, thus saving the NHS lots of dosh that they obviously didn't spend on quality transcription.

Shame that not everyone is sufficiently IT-literate to do so. Still, I expect a few years of natural selection will improve the population.

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and

Shame that not everyone is sufficiently Medic-literate to do so.

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Pint

The records contain errors?

Could this be the result of people trying to read doctors' legendarily illegible scrawl?

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RW

Stupid is as stupid does

If the people trying to build and populate this system are terminally stupid, it's partly because UK government, both national and local, is run by amazingly stupid people these days.

Stupid people in positions of authority invariably resist any input from intelligent people under them, quite rightly believing that it threatens their cozy way of life. Hence, stupid leaders prefer to hire people even stupider, and as you descend the ladder of authority you get into realms of sheer idiocy and moronism.

This is also tied up with NuLabour's distaste for anything that might be construed as elitist, such as intelligence, education, experience, and a realistic outlook on life.

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or does some more

If the various branches of government are being run by "amazingly stupid people", someone should look into how that happened.

Oh, they got there because someone voted for them? Perhaps that's the source of the problem then.

Still, it does seem very odd that the people of Britain consistently vote for "amazingly stupid people" all the time. Sounds more like a bullshit theory with no basis in fact to me. Maybe you're the amazingly stupid person who drags down the average.

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Anonymous Coward

I...

opted out not because of the lack of accuracy, but because of the massive amount of people with access to the data.

Not the medics, the rest: Which includes the benefits people and the local taxation department !

AND, apparently, Capita...

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U U UCL not saints

Who was it who wrote the report? Doesn't UCL have an interest in this, ici, http://www.openehr.org/ - which seems to be a re-write of w3's semantic web / xproc, but what the hey.

AC@14:33's comment suggests a lack of flexibility in the implementation - I don't know why they couldn't add new categories. I see they're using HL7 (the standards body with a marketing strategy, hmm..), whose specs are "open" for a fee, so it's difficult to tell if the rigidity is inherent in the system. Anybody willing to stump up £130 to find out? Otherwise it's goodbye £12.7bn in a series of hefty re-writes - and I so wanted that ivory back-scratcher.

There are some WSDL's here, http://www.connectingforhealth.nhs.uk/systemsandservices/interop/standards.

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Anonymous Coward

Quality

The solution to data quality?

Transfer the paper records to the database, print them out and send back to the patients. Then let the patients check it themselves! if they don't know what medication they're on or what disease they've got, then there's no f**ng hope is there?

As for data quality, NHS connecting for health didn't want to set the standard too high as GP surgeries wouldn't upload the data.

So what data quality is acceptable? Simple answer to this one folks. 100% accuracy, otherwise what's the f**ng point?

One mistake in the medication, treatment regime, or medical condition of a patient and they could be given the wrong drugs, wrong treatment, with potentially very serious consequences.

You can't compromise on this one. Get it right or don't bother.

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Ahahahah

Oh ye of too much faith...

I'm both a volunteer EMT, a first aid/CPR instructor trainer and admin a patient system.

Patients are users. Think about this fact and what it means for your scheme. The average patient knows as much about his body as the average user does about his computer. Something used to work, it doesn't anymore, they go get help to get it fixed. End of.

Me: "Are you taking any medication sir?"

Patient: "Yes, the small white ones"

I wish I was kidding.

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Paris Hilton

Never?

Never have so many been diddled by so few for so much?

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WTF?

so one of the core justifications for the £12Bn+ investment

Works very badly.

remind me how long this project has been running.

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"Quality"

<<So what data quality is acceptable? Simple answer to this one folks. 100% accuracy, otherwise what's the f**ng point?>>

The point would be, the good that is done by fast access to correct data, compared to the harm done by innacurate data. As long as the former outweighs the latter, thats the point.

To say that something should be 100% correct or not done at all is idiotic, nothing is 100%, and that would even include the situation if records were sent back to patients to correct - inevitably, some patients will mess up their records when they were correct in the first place. (It might be a good idea to do that but it wont get you perfection - you can't have perfection )

I'm presuming you don't decline drugs, antibiotics ,or operations on the grounds they arent 100% safe?

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93C3

Just make sure your GP puts Read Code 93C3 on your record (prevents upload to SCR system)

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Gigo, indeed.

I am reassured that at least they staple the Post-It notes onto the patient records now. It isn't hard to imagine how they found a need to do that.

Different health boards using different unexpanded codes for the same thing is less of a problem, I think, than using the same code in different counties for different things. For instance NFN "Normal for Norwich" only makes sense in the neighbourhood of Norwich. But does CTD meant "Cardiac tremor detected" or "Circling the drain"?

As broadcasting doctor Phil Hammond has said a few times, these little jokes aren't so funny when they're read out in court... I'd say keep your local shorthand if you like but store it alongside a proper technical term; a computer can cope with that - Wikipedia can... [ASA::{amazed-still-alive}] Easy.

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Dodgy data, not a dodgy database

AC - My Experience - Friday 19th March 2010 14:09 GMT

I'm sure you're right. If the data being uploaded to the NPfIT database from GPs' surgery systems is poor quality, it's not going to improve in quality just by being uploaded.

AC - crap medical databases - Friday 19th March 2010 14:33 GMT

"... little room for additional explanation, clarification or subtlety that might exist in the paper records." An important point - the database is apparently removing the ability to include notes to explain / modify / temper the bald facts recorded.

When we in Scotland had our (minimal) personal data uploaded to the equivalent database, we were given the option to ask our GP surgery to provide a printout of the data being uploaded from their system. I asked for mine on my next visit but my GP couldn't figure out how to print it off and offered to show me it on her screen instead! Shucks.

It's foolish to rant and blame every fault on the government, or the computer project. No record system, whether held on paper or on computer system, is ever going to be 100% accurate.

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Nonononono

"Delete National Record" is the code to use if you don't want to be on the database...

(Sooner or later...)

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