Intended for healthcare professionals

Analysis And Comment For and against

Patients should have to opt out of national electronic care recordsFORAGAINST

BMJ 2006; 333 doi: (Published 29 June 2006) Cite this as: BMJ 2006;333:39

Although some aspects of the NHS care record service have a broad consensus agreement, issues of consent and security are dividing health professionals, the public, and the national programme for information technology. Nigel Watson believes his experience of opting out shows it to be the most workable option, but John Halamka uses a US model to argue that opting in is the only way to ensure confidentiality


  1. Nigel Watson (, chief executive1
  1. 1Wessex Local Medical Committees, Winchester, SO23 8TA
  2. 1Harvard Medical School, 1135 Tremont, Boston, MA 02120

    Health care is becoming more complex and is often delivered in different places by several professional groups. At present many records are still on paper and electronic records often do not link up. For example, although general practice electronic records are among the most advanced in the NHS,1 they are not normally available when the patient is seen out of hours or attends accident and emergency or another practice as a temporary resident. Electronic coded clinical communications between hospital and general practice systems are limited to pathology.

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    How should she choose what records the doctor can see?


    The NHS care records service lies at the heart of the national programme for information technology.2 The service will provide electronic summary care records and detailed care records that are available throughout the health service. The concept of appropriate electronic clinical information being available to legitimate healthcare professionals is not contentious. Most people agree that patient centred care requires comprehensive information to be available wherever and whenever care is provided. There is less agreement, however, on how patients should consent to use of electronic records and how the data can be kept secure.

    Models of patient consent

    There are two broad schools of thought. The first, characterised as the opt-out model, is for the public to be informed of the NHS care records service and to be offered a chance to express their wish that …

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