We've all done it: returned from a psych ward round and regailed a history of Prof X (a patient: 60yr old, wheelchair-bound man who believes he can control peoples minds) to our peers. He was referred by his GP, but he hadn't brought a referral note with him, so you took a full history. He was quite embarassed but you reassured him that he was completely normal as you sidestep out of the door and scribble 'delusional' in his notes, signing 'Medical Student' at the end.
Of course, you were well within your rights as a professional-in-training to discuss the case with your peers, as you had anonymised the case. Confidentiality remains and everybody's happy.
But we're now in the cyber-age of the NHS' National programme for IT (NpfIT), a large part of which is the Care Records Service (CRS). In theory, given Mr X's demographic details you could find all his previous medical history on a nearby terminal and would have known that he's actually been receiving gene therapy to suppress his mutant gene and so shouldn't be on the psych ward.
However, you could only do this if you had the required permission to access his data, but you're only a medical student and so don't even have a smart card to log into the CRS.
But let's say you were his GP. You have access to all Prof X's records: previous hospital admissions, immunisations, drug history etc. All at the click of a few buttons. This is useful as Prof X is getting senile and doesn't remember much of his past.
As a proactive GP, caring for public health: you try and check his parents' records (beginning to sound like facebook for the NHS?). However, in order to respect patient data rights, the CRS will allow information to be hidden from those not directly involved in care, if the patient wishes. His parents both turned up their privacy settings as they didn't wish to disclose their mutant status.
Meanwhile, a crazed hacker, Mr M, has managed to gain super-administrator rights to the CRS (alternatively, he could have just stolen a smart card from someone who has these rights) and has found out that Prof X is a mutant. Mr M finds him in an attempt to persuade him to join his pro-mutant organisation. Prof X declines and a war between super-powered mutants ensues, resulting in the near-destruction of mankind as we know it. And all because of NpfIT.
OK, so NPfIT may not destroy the world but it has the potential to cause huge changes in patient care within the NHS, minimising paperwork, allowing instantaneous access to patient records in A&E settings as well as increased opportunities for measuring public health and even the potential for tracking dangerous doctors. And at a cost exceeding £18 billion, it better make a difference!
Luke Yahanpath, (BSc at RUMS) published 12/06 in medical student