The difficulty of integrating the records of every NHS
patient in the UK onto one lifelong electronic record has been
vastly underestimated, according to a recentBCS Health Informatics Forumworkshop.
Meeting to scrutinise the ongoing work on electronic health
records as part of the government's
National Programme for IT
(NPfIT), BCS Health Informatics Forum members identified
several problems that made the government's proposed "one patient,
one record" system unsustainable.
Members agreed that the move towards more patient-centred and
collaborative healthcare delivery was inevitable, but they felt
that with the variety of healthcare services and records that
exist, the government's approach was unrealistic.
Deciding who should have access to the data was identified as a
major challenge. Members could not agree on whether local
pharmacists or practitioners of alternative medicine should have
access. Whatever the government decides on such matters, it is
likely to prove divisive.
Concerns were also raised as to whether the government would be
willing to vest ownership and control of access to the record
primarily with the patient.
Beyond the theoretical problems, the technical challenge of the
project was seen as a major stumbling block. Records contain data
collected at specific times, and in developing any records
architecture thought must be given as to what data to collect and
store long-term, with a view to what might be needed or relevant in
the future.
This is particularly important when those contributing to the
record are not necessarily those who use it, with the result that
much that is implicit must be explicitly recorded.
The group suggested that additional tools for visualisation
would be needed to cope with the explosion of data resulting from
the digital recording of clinical measurements and images.
It was felt that there was not sufficient understanding of this
issue by government, and a computer science perspective was
required. Also, much of the work might only be possible through the
national organisations responsible for implementing electronic
health records, and cannot be undertaken alone by volunteers within
a charitable organisation such as the BCS.