Version	Date	Amendment History
V 0.1	27/07/07	First draft
V 0.2	01/08/07	Team Review
V0.3	03/08/07	Sally Updated to reflect Info Examples

Forecast Changes:

Anticipated Change	When

Reviewers:

This document must be reviewed by the following. Indicate any delegation for sign off.

Name	Signature	Title / Responsibility	Date	Version
Jo Nash	Email
Martin Tallis	Email

Approvals:

This document requires the following approvals:

This document constitutes part of the Sealed Envelopes Supplier Requirements Documentation and will be approved within that document.

Name	Signature	Title / Responsibility	Date	Version
Jo Nash		Sealing Project Manager	03/08/07

Distribution:

Document Status:

This is a controlled document.

This document version is only valid at the time it is retrieved from controlled filestore, after which a new approved version will replace it.

On receipt of a new issue, please destroy all previous issues (unless a specified earlier issue is baselined for use throughout the programme).

Clinical Scenarios

1. Sealing

1.1. Sally

Sally, a 20 year old student, is brought to the Emergency Department with heavy PV blood loss. Reception staff accesses PDS via the Local Service Provider (LSP) system, which confirm her details and legitimate relationships (LR) are created for the ED team. This shows that she is registered with a GP in Harlow.

Sally is seen by the emergency department physician who accesses the LSP ED system using a smart card and PIN and selects the entry for Sally on the LSP - ED system, which opens a screen allowing clinical details to be entered and also displays Sally's Summary Care Record held on PSIS. She confirms that the information retrieved from PSIS is correct. It showed that she has been taking the OCP and was prescribed a course of penicillin two months ago to treat tonsillitis. It is also noted that Sally's LMP was 8 weeks previously.

When questioned she said that she had been sexually active during the last few months. On examination, Sally has supra pubic pain and low back pain in addition to the bleeding PV. Sally's vital signs are recorded; none were compromised.

A urine pregnancy test was found to be positive and a differential diagnosis of ectopic pregnancy or miscarriage is made. Sally is admitted to the 24 hour observation ward and is given analgesia. She has some blood taken for testing, including a full blood count, blood group in case Rhesus negative and a Kleihauer test.

The next day, an U/S scan confirms a blighted ovum. Sally is keen to return to her student home. She is discharged by the Gynaecology Registrar, who gave her an advice leaflet and he instructed her to seek advice if the bleeding did not stop. An Emergency Department Report of Sally's care is written and saved on the Local Service Provider (LSP) system.

Sally is prescribed co-codamol, which is collected from the pharmacy by the nurse.

Later that day, Sally's Kleihauer test result is returned as positive, she is confirmed as Rh-Ve. These results are reviewed by the gynaecologist, who completes the Emergency Department Report including a request for the GP to undertake anti D immunisation as per local policy. He verifies the report and sends it to PSIS and to the GP's system. The Gynaecology Registrar phones the GP's surgery to advise the GP to read and act upon the report he has sent.

Sally attends a follow up appointment at her GP’s, at which the GP explains what the registrar has sent to him. The GP says he would like to act on the registrar’s advice and conduct some further tests and Sally agrees. At the end of the consultation Sally asks if she can Seal the episode as she is concerned about who can see it (her mother works at a neighbouring hospital). The GP agrees and retrospectively Seals the whole report and a notification is sent.

2. Unseal

2.1. Sally

Two weeks later sally visits the GP once again for test results and a check up, and the GP tells her that he would like to send her back to the registrar as he has some concerns that he would like a specialist to take a look at.

During these 2 weeks Sally has re-considered her decision to Seal the information, and requests the GP Unseal the information stored on PSIS.

The GP unseals the report and a notification is sent.

2.2. Alice

Alice, 15, and her mother (Mrs Sue Percival) attend a routine appointment at Alice’s GP (Dr Brighton). When Alice was 13 she suffered Bullying and was physically assaulted on one occasion. She attended the GP surgery for this, was treated and Mrs Percival sealed this episode on behalf of Alice. Alice is now 15 and Mrs Percival feels that is Alice’s decision whether this remains sealed. Alice has said she does not feel sensitive about the issue, and indeed would prefer it to show on her records, for this reason Mrs Percival has now requested that the information be unsealed. The system logs Mrs Percival as the requestor for this action, and the information is unsealed on the local system. A notification is sent.

3. Refusal

3.1. Paul Smith

Paul has a history of drug abuse, including several overdoses. He approaches his GP and requests that he seal anything relating to his drug addiction. His GP is aware that is Paul is still a drug addict, and refuses to seal any of the various drug related episodes – citing Public interest as a reason. The GP records the refusal.

4. Automated accessor group change

4.1. Mark

Mark has just moved from Dorset to Devon and wishes to register at his new local GP surgery. Upon arrival the receptionist logs onto their computer system in order to locate his Summary Care Record and confirm his identity. She then invokes the GP to GP process which retrieves Mark’s record. The information he has previously sealed will be sent, though any Sealed & Locked information will remain, Mark was advised when he sealed and locked his information that it would not be transferred should he move and he is still happy that his information is left behind in Dorset.

5. Accessor group change

5.1. Sally

Due to a local re organization Sally’s GP has combined with another local Surgery to form a large medical centre. This means that the workgroup that used to have access permissions for sally sealed information has now had a name change. This is done; no action is needed from the patient. A notification is sent.

Ref no	Doc Reference Number	Title	Version
1	NPFIT-FNT-TO-REQ-DEL-0142	Sealed Envelopes Supplier Requirements Documentation	3.0