Health officials in the U.K. have added an extra hurdle for patients who wish not to be part of a large-scale electronic medical records program, requiring them to appear in person to explain why they want to opt out of the system.

In May, the British National Health Service will roll out a plan to allow authorized medics and nurses across the country to access patient medical records. Currently, the information is seen only by the patient's primary care physician. A new initiative, Summary Care Record, would ensure that staff at hospital accident units nationwide can access patients' information before treating them.

The NHS is testing the system at a few sites in south Birmingham and Stoke-on-Trent. Patients have been notified of the initiative and are told if they do not wish to participate they must register their objections in person, according to Pulse, a newspaper for U.K. general practitioners.

"If you do not wish to have a Summary Care Record, you will need to make us aware of this choice in person. Please use the contact details below, and we will make arrangements for you to do this," said letters to patients from the chief executives of NHS South Birmingham and NHS Stoke-on-Trent, two of the initiative's test sites.

The letter then directs patients to call the NHS Care Records Service Information Line or the PCT Patient Advice and Liaison Service, where they are given information on drop-in sessions with NHS advisers.

In south Birmingham, general practices sent letters to 77,614 patients, 517 of whom have opted out in person.

The initiative has angered some British physicians who complain that patients are unduly pressured to take part in it.

While many patients are comfortable having their records uploaded electronically, a large minority have concerns over privacy, according to Richard Hoey, Pulse's deputy editor.

"Given this, it is absolutely essential that the NHS does not throw up barriers to make it difficult to opt out. It is bizarre that opting out of having a care record can require an in-person appointment whereas applying for a driving license does not," he said.

The letter has also been called intimidating.

"For patients worried about privacy anyway, the last thing they want is to go and justify that to some official. It's appalling they're going to torture someone basically," said Dr. Grant Ingrams, chair of the IT subcommittee of the British Medical Association's General Practitioner committee and secretary of the General Practitioners Committee West Midlands.