Peter Singleton

Potential of electronic personal health records

Novel methods for helping patients to access and manage their personal electronic health data are emerging in the UK and internationally. Claudia Pagliari, Don Detmer, and Peter Singleton examine their potential benefits and challenges

Electronic health records: new opportunities for clinical research

Clinical research is on the threshold of a new era in which electronic health records (EHRs) are gaining an important novel supporting role. Whilst EHRs used for routine clinical care have some limitations at present, as discussed in this review, new improved systems and emerging research infrastructures are being developed to ensure that EHRs can be used for secondary purposes such as clinical research, including the design and execution of clinical trials for new medicines. EHR systems should be able to exchange information through the use of recently published international standards for their interoperability and clinically validated information structures (such as archetypes and international health terminologies), to ensure consistent and more complete recording and sharing of data for various patient groups. Such systems will counteract the obstacles of differing clinical languages and styles of documentation as well as the recognized incompleteness of routine records. Here, we discuss some of the legal and ethical concerns of clinical research data reuse and technical security measures that can enable such research while protecting privacy. In the emerging research landscape, cooperation infrastructures are being built where research projects can utilize the availability of patient data from federated EHR systems from many different sites, as well as in international multilingual settings. Amongst several initiatives described, the EHR4CR project offers a promising method for clinical research. One of the first achievements of this project was the development of a protocol feasibility prototype which is used for finding patients eligible for clinical trials from multiple sources.

Confidentiality of personal health information used for research

Researchers must balance the quest for better health for all against the need to respect the privacy of research participants. What needs to be done to ensure best practice?

Time for a reality check of NPfIT’s problems

Problems with technology, contracts, timescales, organisational change, and user acceptance have continually dogged the NHS national programme for IT (NPfIT),1 but critics need to get these into perspective before seeking to tear down the enterprise. Similar difficulties have historically beset most large information technology projects in the corporate and public …

Trust and Privacy in Healthcare

This paper considers issues of trust and privacy in healthcare around increased data-sharing through Electronic Health Records (EHRs). It uses a model structured around different aspects of trust in the healthcare organisation’s reasons for greater data-sharing and their ability to execute EHR projects, particularly any associated confidentiality controls. It reflects the individual’s personal circumstances and attitude to use of health records.

Patient experience should be recorded in health records

Simply giving patients access to their records is relatively pointless, apart from showing openness and transparency.1 There is already a legal obligation (under the Data Protection Act 1998) to provide copies of records on request. Patients often assume that their records are very detailed and …

Using/abusing freedom of information requests

I am not sure what Breathnach and colleagues are suggesting: allowing the media to use the Freedom of Information Act but preventing possible research studies using the same legal right?1 It scarcely sounds as though this has become a major problem compared with subject access requests under …

Selecting Medical Students: Beware of self selection and self fulfilling prophecy

Because the BMJ is mostly read by clinicians, we should be aware of the risk of self selection.1 Just as companies can develop an internal culture, whereby only similar personality types are recruited, so the same happens with doctors. We select only those with high academic results, we train them to be problem focused, and, not …