Medicine and leading edge technologies have always gone hand in hand over the years, and with the recent explosion of information technologies, medical practice has certainly been at the forefront. Over the recent past in the United Kingdom, there has been a dramatic shift in the way medical records have been created and stored. There is an undoubted move towards using electronic medical records as the gold standard of recording medical information and in primary care in this country, this is virtually the normal mode of practice. Most primary care units are either paper lite or paper free.

With the pen being replaced by the keyboard and stuffed and often crumpled paper medical notes replaced by a computer screen, this has led to a dramatic and fundamental change in the way primary care physicians work. This was dramatically brought home to me when we recently changed our clinical software system. It certainly was a culture shock to have to record data in a different format and method but an interesting educational experience, all the same. It also brought home to me, how fundamental our PCs and clinical software are to everyday general practice.

Of course general practice is just one slice of the NHS empire, and the NHS Connecting for Health project, an ambitious scheme to electronically unify all the segments of the NHS. Naturally and not surprisingly, this is a hugely expensive project but having as one of its offerings, a regularly updated and accessible electronic medical record available to all health professionals, offers potentially fantastic possibilities to improve healthcare. Of course Connecting for Health does far more than just produce electronic medical records, it is active in many other areas. But let’s look at this a little further.

The NHS Connecting for Health project also has a high political profile, not only because of its cost but because of the ethical issues it raises, particularly about access to medical records. Who gets access and amends them, who gives consent and who is responsible for what are just some of the big issues that electronic medical records throw up. So it was with great interest that I recently read in the Times newspaper, that the UK Conservative Party may be considering other alternatives. Since a general election could happen within a year or so, then the current opposition’s policies will attract attention.

The core of the idea is to farm out the storing of health records, not to a centralised, healthcare provided system as currently envisaged but to use standard public and well known IT businesses such as Google and Microsoft. I don’t want to go into the politics of this, (I will leave that to the politicians) but it is an interesting and certainly far cheaper concept. This means that patients will have far more control of their data which in today’s modern society certainly is the trend. However after thinking carefully and reading widely, I am having some doubts. There was also an excellent BBC blog covering this specific area.

One of my doubts centres around how much money we have spent already. Since we have come part of the way through the Connecting for Health project, does that mean if we change direction so abruptly then could this mean that the money invested in current projects, will be wasted?

Also if patients are suddenly empowered what about the people that are not computer literate, don’t have easy access to such technologies or simply can’t be bothered? How do they manage? Other practical problems come to mind, how are these clinical records in private servers updated-who does it and who is responsible? If the GP has one form of an electronic medical record which is not synchronised with the one say on Google server, which one is the more realistic and dependable one? Not to mention what will the private providers do with this rich seam of medical data sitting on their servers? I am sure they will be keen to try and exploit their commercial potential. Maybe I am being too cautious here but medical data is a precious commodity and since we have our main healthcare provider-the NHS, it follows that the NHS should have ultimate control of this data

The questions are endless and the answers are currently limited and to be fair to the politicians involved, we don’t know all the details of this proposed policy. However it shows what a complex area, the subject of electronic medical records are. Perhaps compared to the difficult questions, I have just posed, changing clinical system within our practice was not that complex after all!

Harry Brown is a general practitioner in Leeds.

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