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Should patients have to opt out of electronic records?

The potential benefits of sharing patient electronic records within health systems are broadly agreed, but concerns remain over patient consent and security. Experts in this week's BMJ discuss how patients should consent to use of electronic records in the NHS and how the data can be kept secure.

There are two broad schools of thought. The first (the opt-out model) is for the public to be informed of the NHS care records service and to be given a chance to opt out if they do not want their clinical records shared within the NHS. The second model is for no sharing to occur until people have expressed their desire to share their clinical records within the NHS (the opt-in model).

Nigel Watson, Chief Executive of Wessex Local Medical Committees, has experienced an opt-out approach and believes that this is the way forward.

He cites existing opt-out schemes that have been widely accepted by health professionals and the public, and points out that the health service in Alberta, Canada, changed from the opt-in position to an opt-out one in 2003 after consultation with both patients and clinicians.

In his own area of Hampshire and the Isle of Wight, only 1150 out of the 1.3 million patients have decided not to have their records included in the repository.

In terms of security, access to a patient record in the repository requires a user name and password, he adds. User names are only issued to staff with confidentiality clauses in their employment contracts, and before accessing the patient record the user is asked to confirm that the patient has given consent.

He believes an opt-out model should be used for the NHS care record service, as it allows patients to benefit from earlier availability of information, reduces the workload on hard pressed services, and cuts the bureaucracy for both practices and patients.

However, he stresses the need for a large publicity campaign six months before the start of the
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Contact: Emma Dickinson
edickinson@bmj.com
44-207-383-6529
BMJ-British Medical Journal
30-Jun-2006


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