14 September 2022: Armstrong - B

And so, to the questions from Core Participants:

On “open” and “closed” records, and very old records; he said he was not aware of the distinction, but he had heard of some older notes going to the Welcome Trust for their historical value. It might be an issue for data protection now though.

On microfiche records in Scottish hospitals; he said he did not know anything about that.

On the state of the digitisation of records across the UK; he said it was at different stages across the country. A few were almost completely transferred, while others still relied heavily on paper files.

On people with more than one condition, and long-term conditions such as a bleeding disorder patient; he said it would be important to hold records until well after the patient had died due to the complexities, and haemophilia would be a good example.

On Hepatitis record retention; he said such patients may have long-term consequences so records should be retained since they would have value right across the patient’s life.

On interactions between hospitals; he said they can access some information through the CHI number, but usually not all digital information. It would be more likely to become a request for the holding hospital to send records over.

On a case of a patient being away, such as on holiday; he said that that could be more difficult and would likely involve a personal intervention with the one who knows the patient advising the clinician in the holiday destination.

On the range and number of people getting records access in a team context; he said it can end up being many people.

The Chair asked about a “mega computer” linking all NHS services he had heard reports of. The witness said it was probably the “Connecting for Health” initiative. Big IT systems are very difficult to achieve. The biggest problem is getting different platforms to talk to each other. There is also the issue of people being familiar with their system and having problems changing.

The Chair asked about the patient having a “digital passport” to carry with them. The witness said there are some apps which do that. It would require the hospital to have access to the app content. Often incidental medical interactions are reported through the GP, but these tend to happen retrospectively. There is also the need to manage the security issue, in the ways the big social media companies seem to have done. An incremental shift might be a better option than a single big solution route.

The Chair asked about the HES statistical records system and how that connects with general medical records. The witness said it is very coded and data-driven, and does not include particular treatments and, of course, there is the matter of keeping the patient identity private. Also there is the possible need to obtain permission to use the patient’s information in research.

The Chair asked about culling, and the risk of the loss of important medical history. The witness spoke about the example of patients having symptoms that are not attached to a diagnosis as a reason to keep information which could be useful in the future, but there is an issue of keeping everything just in case it might be useful but actually clogs things up.

The Chair asked about the career pattern for clinical record keepers. The witness said it might be a mix of a librarian and an IT specialist.

The witness had nothing to add.

The Chair thanked the witness as an enthusiast for his subject.