From Mr K. R. Smith, MRPharmS
SIR,—I and some other colleagues are a little concerned about the direction of progress with pharmacist access to electronic data through the NHSnet.
It would appear that the Society takes the view, that since pharmacists may not understand the implications of the occasional obscure diagnosis a patient may have, they should have access to no diagnostic information. The argument appears to be that, once provided with the information, pharmacists would be liable for any action (or omission) that results in harm to a patient, if, given the information, some other action could have been taken to prevent that harm.
In other words, pharmacists would be protected by their ignorance of the patient's problems.
Aside from the small fact that patients clearly will not be protected from the pharmacists ignorance (which, it has to be admitted, is currently the case), this misses an incredible opportunity for pharmacists to take a more active role in the clinical care of patients, to become more involved as active members of the primary health care team, a role which the Pharmacy in a New Age initiative seems to advocate, and which Professor Mike Pringle urged pharmacists to take in his address to the British Pharmaceutical Conference on September 14 [see p490].
As far as I am aware, there has been no debate in the PJ on this, and most pharmacists are therefore unlikely to be aware that the Society is advocating this route.
There are a few caveats. First, I learned of this in a session on the legal and ethical issues surrounding patient information stored in computers and manual systems, where speakers included Mr Ian Shepherd from the Society, and we did not have time to debate this, nor clarify the exact status and position regarding this. If I have misunderstood, I would be grateful for an explanation of the true position. However, it is too important to ignore, and any change in position needs to be undertaken urgently.
Secondly, I have a background in hospital pharmacy, where access to patient's notes is accepted as essential to the proper provision of pharmaceutical care, or effective clinical pharmacy. Although I do not believe it, and conversations with community pharmacists I know would not support it, it may be that most community pharmacists would prefer not to have the responsibility of knowing the diagnoses, and problems, of their patients.
Thirdly, there may be an issue that getting electronic connections is so important that we need to duck potential arguments about access to information more sensitive than that already provided on an FP10. Surely this cannot be the case?
Finally, there is an issue about confidentiality of information held in, and accessible to pharmacies. Mr Shepherd pointed out that many systems in pharmacy have not been set up to use the security facilities available. Patients tell me that while they trust pharmacists, they may be less trusting of pharmacy assistants. In the league of trusted persons, where do they actually figure? I do not question the integrity of the vast majority of pharmacy assistants. The perception may differ from the reality, but the perception is all important. Any clinical information held in a pharmacy should be available only to those who need it, and patients need to be assured of this. This may simply mean requiring pharmacists to comply with the same sort of code of connection security already used for general practitioners who want to connect to the NHSnet. In the meantime, of course, it would be worthwhile for pharmacists to consider the security of patient information they already hold, as suggested in the consultation document on the code of ethics.
At the very least, I think the profession should have an opportunity to debate the proposed standard for the content of clinical information pharmacists should have access to.
Kevin Smith
Brecon, Powys
Mr Ian Shepherd (head of the Society's information management and technology policy unit) states: I welcome the opportunity to clarify a few points and, indeed, to stimulate further discussion and debate on this subject area. First, my presentation was to the Pharmacy Law and Ethics Association and was intended to explore the issue and to stimulate debate. It was certainly not a statement of Society policy.
The Society's view is that pharmacists should, in the patient's interest, have access to patient records, including diagnosis, laboratory results, allergies and other clinical data where relevant to medicines management.
The point I was making is that we need to think carefully about the consequences of access to information and whether it would alter our behaviour or not. The fact that your correspondent has thought about my comments is heartening. The issue of accountability is both interesting and important.
My view is that we will need to proceed with care, taking patients and other health professionals with us. The issues will certainly change in the "electronic era", and we must act to ensure that pharmacists fully understand their accountabilities, which do change with time. Continuing professional development and working practices will need to take account of this.
As a profession we need to progress, but it is important that we do this with care, and ensure that patients interests are central to this and properly taken account of.