Leaked government review plans new law to push data sharing

A draft of the report on overprescribing, carried out for Matt Hancock by NHS England, says a major problem is that clinicians in different parts of the system can’t see what’s been prescribed and dispensed elsewhere. It says “wider access” should be given, which would also ensure “many eyes” are looking at the data to detect patterns or problems.

This should include making it a requirement that prescribing apps make their data openly available, according to the report by chief pharmaceutical officer Keith Ridge.

NHSX should be tasked with creating a “mechanism for people to alert them to information blocking in the short-term… and with investigating potential policy or legislative intervention in the intermediate-long term”, the report says.

Another proposal is for a “data barriers notification system” so mistakes in records can be easily highlighted — similar to systems for reporting of patient safety errors.

NHSX should also be asked to create a mechanism for “reporting data errors in a patient record to the appropriate data controller so that they can be corrected [with a mechanism] quicker than a full DATIX [error] report”.

The draft seen by HSJ — dated this autumn — recommends private providers should be required to share prescribing data, and action should be taken so private and secondary care prescribers can add this information to a patient’s GP care record.

The review into overprescribing was commissioned by Mr Hancock nearly two years ago when he said: “Poorly managed prescribing can lead to serious issues for patients such as increased admissions to hospital or antibiotic resistance.” It is unclear why it took so long before coronavirus hit.

NHS Digital chief executive Sarah Wilkinson told HSJ  last month that law was needed to enable greater data sharing within the health service after covid measures expire — how much crossover there is between this and the prescribing proposals is unclear. There is a growing movement for this, but it would likely face strong privacy concerns.

The draft review report says poor interoperability between NHS computer systems means clinicians cannot see or understand what medications patients are taking and why. They are also unable to see exactly when a medication should be reviewed.

The report states: “As information on medicines is often held in multiple locations we are generally unable to see a single comprehensive record. Because we don’t have ease of data sharing, we don’t understand what patients are taking and why.

“Shared records enable clinicians at the point of care to access information, to provide better safer care for patients. The NHS lags behind other sectors in the interoperable transfer of information between systems. Work on interoperability is now a priority for NHSX and facilitating the digital transfer of information from hospital to GP is an early priority.”

It also states: “The use of technology may be inadvertently driving overprescribing given the ease of selection [of multiple prescription items]. This is particularly pertinent with order sets when multiple medicines might be selected with one-click.”

The report raises concerns that poor communication between clinicians and patients means patients are not able to make informed decisions about the medications they receive. It adds that there are currently “perverse” financial incentives around prescribing and dispensing, though it does not specify what.

The report says there is “new data to collect” in the NHS, according to the report. It recommends that prescribers should be identified in the health record so other clinicians can contact them if needed. A free-text box should be created in EHRs so clinicians can explain why a patient has been prescribed a medication, it says.

A spokesman for NHS England said: “This was an uncorrected draft report, which after it has been properly fact checked will be published in due course.”