Access to electronic patient records being trialled in the UK.
Since 2014, 125 community pharmacies throughout the UK have been invited to participate in a trial whereby they were given access the (partial) electronic records of patients called Summary Care Records (SCR).
Although the trail has not yet concluded, already some very positive evidence is being generated.
In the majority of the situations where pharmacists accessed the SCR potential harm to patients was avoided, with a significant proportion of these being episodes where a prescribing error was identified and prevented. In several cases pharmacists have accessed the electronic records to make a small inquiry, and have identified and prevented potentially life threatening situations. It is obvious that access to the SCR has clearly improved patient safety.
Currently, the SCR is also being used in situations where a vital piece of the jigsaw is missing. In the vast majority of cases where the Summary Care Record was accessed, pharmacists did subsequently not need to send the patients back to the doctor as they were able to resolve the issue within the pharmacy.
It is already possible to see how the use of the SCR could transform community pharmacy practice and provide pharmacists with just the tool that they have needed to be able to do justice to the vitally important task of the performing a clinical check.
How to use the Summary Care Record
There is no doubt that incidental use of the SCR may be of benefit, but if community pharmacy is to undergo a major improvement in service provision, one in which the professional skills of the pharmacist can be more fully used for the benefit of patients and the wider health service, then the reliance upon the SCR must drive roles for pharmacists that go way beyond just the clinical check of the prescription. The use of SCR must become a core part of practice and not an incidental one seeking only to improve the existing supply service.
A more comprehensive reliance upon SCR would allow pharmacists to optimise the medicines being taken by patients by enabling them to consider the whole patient and not just the whole prescription or the single condition for which the prescription was written. Beyond that, a more comprehensive use of the SCR could allow pharmacists to get on top of the medicines waste issue, to tackle adverse reactions and even help to avoid unnecessary hospital admissions. Furthermore, if used as part of a service which was integrated with other members of the healthcare team, it could create much more capacity for doctors enabling them to see more patients with acute conditions because they could refer caseloads of their patients with longer term conditions to pharmacists. To drive such benefits, pharmacists would need to be routinely accessing SCR with the majority of patient presentations and seeking out opportunities to optimise medicines use.
Without doubt, this role would take much longer than does the current dispensing role and community pharmacy practice would need to be re-engineered. One consequence would be the need to see more than one pharmacist in the pharmacy. One of these pharmacists could be focussed upon this new and much more clinical role and the other would be able to devote more time on the over the counter advice, public health and medicines sales role. This vision would alter the experience of patients collecting their medicines from a community pharmacy as it would take longer and this is a challenge that would require the profession to manage in the most effective way. However, if community pharmacy wants to carve itself a more viable long term future, then it must major upon the development of clinical relationships with patients.