eGov Bulletin reviews Progress towards Electronic Health Records

eGov Bulletin has an interesting piece about the development of electronic health records. The gist of the story carried by this regular email bulletin (see below for subscription details) is that of all the National Health Service's IT modernisation plans, this one will be hardest to put into practice, though crucial to overall success.

"Delivering 21st Century IT Support for the NHS", in which the Government set out its health service targets, requires that all NHS trusts and primary care providers have elements of electronic health records in place by 2005.

Reviewing the Electronic Record Development and Implementation Programme (ERDIP), set up by the NHS Information Authority as a series of pilot studies, the bulletin says that although relatively small in scale compared to the task of fully implementing Integrated Care Records Service (ICRS), the 19 ERDIP pilot projects laid down some useful foundations on which to build ICRS. The pilots explored public response to records; technology and management issues and applications such as information sharing with local authority agencies, and sharing between GPs, hospitals and emergency services.

The bulletin reports that patients that took part commonly expressed concerns about sharing information with organisations outside the health sector such as the police, social services, and commercial organisations. Encouragingly, most patients found the medical terminology comprehensible.

However, the Wirral ERDIP project, which provided cancer patients with access to their records, found that many patients were dissatisfied with the information they received. 'They wanted to be given "a great deal of specific information at all stages of their care". The report identified serious problems with the lack of overall standardisation in the way health information is recorded, and described most written health information as: "Chaotic, fragmented, unco-ordinated and unregulated",' said the bulletin.

Additionally, the Wirral team discovered variation in the way data such as the patient's name and address is currently recorded and used. Combined with interoperability problems, this meant that many ERDIP sites found it difficult to extract information from general practice and hospital systems.

The benefit to patients of sharing information was not always clear. However, an independent evaluation of the Hadfield project recorded some diabetic patients who reported monitoring their blood sugar, weight, blood pressure and diet as a result of accessing their records. The doctor in charge of the practice recognised changes in patients' behaviour as a result of giving them more information about their health.

Overall, there was enormous variety in the use of IT, highlighted by some practices that were virtually paper-less, while others kept electronic records for payments only and stored most patient data on paper. The report recommended tailored, intensive training, including basic typing skills in some cases.

The bulletin's view on progress was this: 'It is clear that ICRS faces some tough challenges. It must be of particular concern that some ERDIP projects recorded few practical benefits of sharing information with patients, which could be used as an excuse to go slow by those health agencies that find it difficult to migrate to ICRS for other reasons. If the system is to succeed, this must not be allowed to happen.'

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