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The British Medical Association has warned doctors away from trialing electronic appointment booking over fears that the system could compromise patient confidentiality.

The Choose and Book system is supposed to give patients more control over when and where they are treated. However, the BMA says the software behind it is flawed. Every time a patient makes a booking, the hospital will automatically download a copy of the patient's medical record from the Care Record Service (CRS), a system the BMA is not satisfied is secure.

Plans for the CRS include a data spine, a national database that will contain a summary of each patient's medical history. In June the BMA advised doctors to boycott the CRS until concerns over security of the database have been addressed. However, this boycott will be pointless if GPs take part in the Choose and Book trial, because data will be transferred automatically to and from the spine of the CRS.

The National Programme for IT argues that the new system will be much more secure that the old system, which involves paper records being sent by post. The flaws in this argument are all too obvious. A single item may be intercepted in the post, true, but a compromised database leaves all records vulnerable.

In addition, doctors could even find themselves in breach of a decision made by local medical committees not to work with the data spine, Computer Weekly reports. The BMA said it would issue a guidance note to doctors, asking them to consider the implications of the Choose and Book service before taking part in a trial.

The BMA is increasingly at odds with the government over the introduction of NHS IT systems. The CRS and Choose and Book were to be Tony Blair's proof that the modernisation of the NHS is going well. However, he now faces a situation where both his flagship projects have been slated as putting patient confidentiality at risk. ®

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