Letters Shared electronic records

What have we really learnt?

BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a2595 (Published 19 November 2008) Cite this as: BMJ 2008;337:a2595
  1. Michael Tremblay, health technology and innovation policy adviser1
  1. 1Brabourne Lees, Ashford, Kent TN25 6RJ
  1. mike{at}tremblay-consulting.biz

    Greenhalgh and colleagues see the shared electronic record as having to respond to existing ways of working and established practices, not the other way round.1 My take is this:

    • Powerful forces in established ways of working in the NHS are hostile to technological changes that threaten established and possibly dysfunctional and wasteful practices. As a taxpayer, this is not acceptable, especially when we need to explore better ways of using tax revenues when times are likely to be hard

    • The scale of complex IT projects empowers dissident critics to feed political interest in their failings. That these projects frequently focus on purely internal (to the NHS) goals and objectives makes them largely inscrutable with respect to benefits that may accrue to patients and their failure more damaging as there are no milestones for delivering taxpayer value. It is better to think of flexible, networked, and distributed approaches—a school of fish adjusting easily to changes in its environment versus a supertanker that is much harder to control. Politicians would be better responding to the benefits that large scale IT projects bring to the public than to internal NHS efficiencies that may result

    • Introducing new technologies must have some consequences, and these are not necessarily helped by protecting incumbents and legacy systems from threat.

    The lack of a patient held smart card for health, for instance, maintains the control of information in the hands of the clinicians and the provider infrastructure. Giving patients complete and total ownership of their health record is a critical way of driving quality improvement.

    My fear is that the sunk costs are already so great that a rethink is unthinkable and that we cannot cut our losses and start again. In politics this would be a U turn, requiring another innovation called courage.


    Cite this as: BMJ 2008;337:a2595


    • Competing interests: None declared.


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