SCR uses the following controls to make sure access is in line with the Care Record Guarantee:
Authentication and Role Based Access Control (RBAC) - use of smartcards
Legitimate Relationships (LR) - The viewer has a good reason to view the patient's SCR as they are involved in their care
Permission to View (PTV) - the patient is asked for their consent before the SCR is viewed. (Emergency access is allowed if it's in the patient's best interest, if they are unconscious or can't communicate.) Permission to view can be gained each time, or it can cover future use as long as the question asked makes this clear to the patient and there is a clear system for recording this
Legitimate relationships and permission to view (or emergency access, with explanation noted) can be recorded by a member of staff such as a receptionist, or by the clinician themselves. Self-claiming a legitimate relationship, or selecting emergency access, will generate an alert. These alerts will be audited by each organisation's privacy officer to make sure there was a valid reason for the view.
Every organisation that views SCRs must appoint a privacy officer. The privacy officer has codes added to their smartcard so that they can access the Alert Viewer on the Spine and check whether SCR views were legitimate. For alerts where the clinician has self-claimed a legitimate relationship, the privacy officer will confirm that the patient was being treated at the organisation by looking at the Patient Administration System or another record of patient attendance. A reconciliation tool, a spreadsheet which helps you check alerts against patient records, is available to help with this. Emergency access alerts are monitored to look for any unusual patterns. Reports can also be run to check patterns of SCR access. If there is any inappropriate access suspected, the privacy officer will investigate it in line with the usual processes for protecting patient information.
Training for privacy officers - downloadable resources.