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Logo of bmjThis ArticleThe BMJ
BMJ. 2008 January 5; 336(7634): 9.
PMCID: PMC2174753
Electronic Health Records

Time for an NHS smart card?

Prasanna de Silva, consultant psychiatrist

Recent correspondence on electronic patient records, including the editorial by McGilchrist and colleagues,1 seems to avoid facing up to a major philosophical difference in approach.

The Department of Health (abetted by the medical establishment) favours securing data centrally for logistic and research purposes. The issue of capacity (or otherwise) of individual people to give consent for this has been neglected. Furthermore, cost and safety concerns remain, along with the risk of system breakdown.

The alternative approach would be for individuals to carry (and be responsible for) their own medical information. An NHS smart card (ideally chip and PIN based) could facilitate this, with the person allowing access to selected staff by using the PIN. Similarly, only staff with an appropriate password can add to the person’s record with PIN based consent.

An NHS card (ideally backed up by facilities to avoid identity fraud) could provide individuals with a wide ranging choice between NHS approved providers—as a referral could be “carried” on the card to a clinic or hospital selected by the patient or carer. Furthermore, the card could also be used for direct payments or an electronic voucher system.

I believe an NHS card would be attractive to a sizeable proportion of patients who have bought into autonomy and self management as regards their health care. Worth a pilot, perhaps?


Competing interests: None declared.


1. McGilchrist M, Sullivan F, Kalva D. Assuring the confidentiality of shared electronic health records. BMJ 2007;335:1223-4. (15 December.) [PMC free article] [PubMed]

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