eHealth unit, Department of Primary Care and Population Health, University College London, UK.
Fam Pract. 2013 Apr;30(2):227-32. doi: 10.1093/fampra/cms069. Epub 2012 Nov 6.
Electronic patient records offer unique opportunities to undertake population-based research. The Health Research Support Service (HRSS) pilot project sought to extract electronic records on a national basis from across health and social care and transfer them together with identifiers to a designated 'safe haven'.
To determine the feasibility and acceptability of the HRSS pilot in primary care.
Interviews and focus groups with patients and practice staff.
There was general support from both patients and staff for the principle of the HRSS. The 'opt-out' basis for participation in the HRSS drew mixed responses from patients and staff, with an appreciation of the advantages in relation to participation by default, but concerns about the extent to which this constituted true consent. Concerns were expressed about confidentiality and the safety and security of the extracted data. The patient information pack was roundly criticized by both patients and staff. Trust in individual GPs, practices and the National Health Service (NHS) was a crucial factor in patients' decisions about participation.
Although patients and staff were generally supportive of the HRSS, they require clear information about the proposed use of medical records for research purposes. The question of 'opt out' versus 'opt in' remains controversial and further consideration will be needed if research using routine medical records is to achieve its full potential as a 'core' activity in the NHS.
电子病历为开展基于人群的研究提供了独特的机会。卫生研究支持服务(HRSS)试点项目试图从整个卫生和社会保健领域提取基于国家的电子记录,并将其与标识符一起转移到指定的“安全港”。
确定 HRSS 在初级保健中的试点可行性和可接受性。
对患者和医务人员进行访谈和焦点小组讨论。
患者和医务人员普遍支持 HRSS 的原则。参与 HRSS 的“选择退出”基础引起了患者和医务人员的混合反应,他们对默认参与的优势表示赞赏,但对这在多大程度上构成真正同意表示担忧。对保密性以及提取数据的安全性和完整性表示关注。患者信息包受到患者和医务人员的一致批评。对个别全科医生、实践和国民保健制度(NHS)的信任是患者参与决策的关键因素。
尽管患者和医务人员普遍支持 HRSS,但他们需要明确了解拟议将医疗记录用于研究目的。“选择退出”与“选择加入”的问题仍然存在争议,如果要充分发挥使用常规医疗记录进行研究的潜力,使其成为 NHS 的“核心”活动,还需要进一步考虑。