Doctors in this week's BMJ have their say on whether patients should have to opt in or out of electronic patient records.
The medical profession is concerned that, in the proposed summary care record, data will be accessed with no further input from the patient, and this is not being made sufficiently clear to the public, write Drs Paul Cundy and Alan Hassey in a letter to this week's journal.
"Patients and clinicians must have confidence that information will be secure and shared only with patient consent," they say.
Another letter argues that the electronic patient record is incompatible with the doctor-patient relationship, and is a direct and serious threat to patient confidentiality. The author, Michael Foley, suggests that the huge sums of money being invested in its development might be more usefully spent on improving patient care than on compromising their privacy.
In another letter, two junior doctors warn that poor training of locum doctors in using hospital computer systems also poses a risk to confidentiality.
Amir Ismail and Muhammad Ismail say that doctors frequently share passwords as it is difficult and often time consuming to attain their own passwords, especially when very short term locums are being undertaken. "This should be avoided at all costs as it compromises data security," they warn.
They believe that locum doctors should ensure that they are given basic training in using these systems as part of their induction at a new hospital, as well as individual passwords. And they conclude that ensuring adequate training at this stage in developing computerised health care is crucial to its eventual success.
If patients' health records are made universally available confidentiality is put at risk and the potential consequences are serious, adds Anthony Winston, Consultant in Eating Disorders, in a final letter. "When serious harm can result from a course of action explicit consent is required. The Royal College of General Practitioners is right to insist on opting in," he writes.