ED physician Anneke Blom calls for nationwide implementation

As a temporary measure in response to the COVID-19 pandemic, emergency departments are able to access information from the general practitioner's record (the so-called summary care record) of patients admitted to the ED with suspicions of COVID-19 infection. The Wilhelmina Hospital in Assen, the Netherlands, frequently makes use of this feature. ED physician Anneke Blom says: 'It improves our ability to care for the patients and it saves the department time and effort.'

You are excited about the ability to access patients' summary care records. Why is that?

Being able to request patient information from the GP's record means we're able to help patients quicker and more effectively. Some patients are known to the hospital, because they've been to hospital before, or because they're from around here. We either have sufficient information, or are able to get any missing information about these patients from past correspondence with relative ease. But when patients from farther away are brought into the hospital, for example after a call to the emergency number, we often know nothing about them. We know why they were brought in, but that's it. The GP record would then tell us all we need to know in order to provide the proper care.

What sort of information would that be?

I would want to know whether the GP has recorded a do-not-resuscitate order for a patient, or whether there are any other considerations or limitations regarding treatment. The summary care records contain a summary of the patient's consultations and contact moments with their GP over the last ten days. We're able to see the patient's current medication, known conditions, and allergies. Not all patients that come into the ED are responsive or able to give clear answers to our questions. Especially for those patients, access to reliable information from the summary care records can make all the difference.

How frequently do you use this feature?

Several times a week. I have to add that we can only access the data if the patient has given their consent to have their most important medical information shared. Unfortunately for us, this is not always the case; I'm able to view the information of maybe 1 out of every 4 patients. Most have not yet given their consent to the GP.

Can you give an example of a situation where the summary care record really helped?

I could give several. We've had patients brought in that had a hospital record, but one so 'thin' that it didn't give us sufficient or up-to-date information. The summary care records we requested for these patients often contained essential information regarding their treatment. It also helped in situations involving patients that were completely unknown to us. I remember one such situation: recently, a patient came in after a call to the emergency number. The patient was unknown to the hospital. Save for their name, we had nothing in the way of information or past correspondence. After we registered the patient in HiX, we were able to view their current medication and relevant patient history thanks to the integrated link to the LSP (the Landelijk Schakelpunt, which is responsible for the exchange of medical data between healthcare professionals in the Netherlands). At the time, the patient was unable to provide this information. Now we could immediately think about treatment, without trying to uncover these pieces of information ourselves. And that's what I am most excited about; it saves us time while improving the quality of care, by preparing us with the right information.

It must also be reassuring for patients, knowing that you and your colleagues are acting on the basis of complete and current data.

Absolutely. Consider this: if a patient has certain allergies and might be at risk of sepsis, we'd want to start a course of antibiotics as quickly as possible. If we would then administer the default antibiotic, and later find out they were allergic to that particular type, the consequences might be life-threatening. You can not 'see' allergies by simply examining the patient. By viewing, or being able to view, the summary care record, we can immediately begin treatment with the correct information.

How does HiX enable you to access the summary care records?

Once a patient has been registered in HiX, the patient's record will contain a link; 'LSP'. When we click on that link, we're able to use our hospital-specific identifier and corresponding code to request access to the GP's summary care record. We then get three options: the patient gives their consent, the patient is unresponsive, or the patient does not consent. Depending on the preference of the patient, we will or will not be able to view the data. If a patient is unresponsive, but having access to their data is crucial, we can decide to access their data. That is, if they have given their consent at the GP.

You mentioned that you can only access the information of around 1 out of every 4 patients. Is that concerning?

It's really not a lot; ideally, I'd like to have the information of 4 out of 4 patients available! But in order to achieve that, it's important for us to raise the necessity and benefits of the solution with GPs. In turn, they can discuss this with their patients. It's similar to how they were able to get access to medication data from the pharmacy, and that's something a lot of people are benefiting from already. This data is also exchanged via the LSP. What's important is that GPs have taken the time to discuss with their patients what they do or do not want. If the patient is brought into the emergency department, they'll often not be capable of making such decisions. The ED in general is not the ideal place to discuss matters such as treatment preferences or wishes. Not only is there often no prior relationship between the patient and practitioner, but such a situation tends to be too urgent and tense for there to be time to talk. We inform GPs in the area about the possibility and benefits of access to summary care records through our newsletters, which are widely read. I hope we'll see an increase in the number of patients who give their consent, and for this solution to remain and even expand. Because it would also benefit those not suspected of a COVID infection.