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 recent BCS Health Informatics Forum workshop.
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.