Feature Electronic health records

Wallet or web?

BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39518.411146.AD (Published 20 March 2008) Cite this as: BMJ 2008;336:637
  1. Michael Cross, freelance journalist
  1. 1London
  1. michaelcross{at}fastmail.fm

Giving patients access to their medical records is generally accepted as beneficial, but as Michael Cross reports there is much less agreement on how this should be achieved

The debate over the electronic medium through which patients will view their health records has gained heat with a set of announcements by a private venture. Backers of the Health eCard, which stores patient records on a smart card the size of a credit card, are overtly citing public concern about the troubled programme to computerise the NHS in England as a reason for patients to pick smart cards rather than the official NHS web channel for access to their records.

Although both sides say they can coexist, the debate illustrates a worldwide battle of media for providing patients and clinicians with access to electronic patient records. The essential divide is over whether records are best stored on smart cards or similar computer memory devices carried by patients1 or inspected online through the internet or dedicated kiosks in, for example, general practice waiting rooms.

Patient records: web or smart card?

  • United States—Web access favoured. Google and Microsoft are trialling free internet based health records

  • England—The NHS has opted for web access through the national programme for IT in England

  • France—The Sesam-Vitale smart card system has been in use for 10 years and is used by more than 220 000 health professionals

  • Spain—In Andalucia, smart cards enable booking of medical appointments

  • Bulgaria—Testing smart cards as an aid to electronic prescribing

In general, the web is favoured in the US, where software giant Google recently followed its rival Microsoft in announcing trials of an internet based health records service. But support for health cards is strong in Europe, where several governments are issuing citizens with identity cards designed to hold medical data.

The NHS, after an early experiment with cards, …

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