Time for a rethinkBMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c3707 (Published 21 July 2010) Cite this as: BMJ 2010;341:c3707
All rapid responses
Push and pull approaches to sharing patient records both pose risks
to patient confidentiality. The push approach "pushes" data into a
"physical" centralised database so that it is potentially available when
required. The pull approach "pulls" data direct from local systems which
collectively form a "virtual" centralised database. The pull approach does
require that records are made potentially available via the "virtual"
database in advance of the information being required.
Whether a push or pull approach is adopted there will be risk of
misuse and loss of patient confidentiality. If one has concerns about
using implied consent for the initial SCR upload which only makes
medications and allergy information potentially available, it would seem
out of the question to use implied consent to make complete GP records
potentially available via a pull approach.
The UCL report found it difficult to demonstrate benefit for a
variety of reasons including unavailability of records. Arguably this is
the most important issue as motivation to resolve other technical and
organisational issues is likely to be lacking if records simply are not
The use of implied consent for the initial SCR upload does make it
more feasible that a large proportion of patients could have SCR records
available within the next year.
Longer term the pull approach will be used to improve sharing of GP
records but it will be some time before all GP data is held on enterprise
systems and available at all times.
Competing interests: No competing interests