Civil Evidence Act 1995 and changing GP systems
peter at pmsommer.com
Mon Aug 9 10:27:00 BST 2010
The main purpose of the Civil Evidence Act 1995 was to admit hearsay
evidence and to provide associated conditions. Section 7 made it
possible to admit copies of documents and section 8 allowed for the
admission of "records" of a business or public authority provided there
was an affidavit / certificate that the records formed part of the
regular business activity.
Thus, the law is about allowing such records to be admitted (whereas
before much more complicated forms of proof were required). Once the
evidence is admitted it is still open to challenge on the grounds of
weight (eg that in some respect it is not accurate). However normally
there will be a rebuttable presumtion in favour of reliablity.
The Civil Evidence Act does not prescribe standards by which records in
electronic form should be kept. There are some applicable
international standards: ISO 18492:2005 and 15801:2009. There are also
some BSI documents: BS 10008:2008.
I don't know if elsewhere there are specific requirements for the
maintenance of medical records.
Off the top of my head, I would guess that the obligation would be to
keep old records in their original electronic format plus the software
necessary to read them. And probably have more than one copy kept in
more than one place for safety's sake. An audit trail in the form of a
document saying when the archive was created and by whom would also seem
to be a good plan.
Unless some-one else here knows better?
On 09/08/2010 08:40, Mary Hawking wrote:
> GPs were allowed to keep their patient records electronically by
> Statutory Instrument in 2000, and the law that allowed the electronic
> EPR in evidence was the Civil Evidence Act of 1995.
> GP practices change systems over the years, sometimes several times,
> and patients move between practices: some systems only transfer the
> records of current patients -- i.e. if a patient leaves the list the
> day before the data is downloaded for transfer to the new GP system,
> the only place that the record will be preserved is on that practice's
> old system.(apart from any print-outs or GP2GP record transfers which
> lack audit trails).
> How does the CEA deal with computer evidence when the
> organisation/individual concerned has changed systems -- and does
> anyone have any references to cases which might be relevant to the GP
> The additional twist in GP records is that for an infant at birth,
> problems can be raised up to 3 years after the age of maturity -- or
> indefinitely if the infant is sufficiently damaged to never reach
> mental competence...
> Genuine enquiry -- topic was raised regarding GP records and keeping a
> copy of the database in an old system: I don't think it has been
> decided in court -- yet -- so I wondered whether there was non-medical
> case law which might be applicable.
> Mary Hawking
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