Intended for healthcare professionals

Information In Practice

The electronic patient record in primary care—regression or progression? A cross sectional study

BMJ 2003; 326 doi: (Published 26 June 2003) Cite this as: BMJ 2003;326:1439
  1. Julia Hippisley-Cox (julia.hippisley-cox{at}, senior lecturer in general practice1,
  2. Mike Pringle, professor in general practice1,
  3. Ruth Cater, researcher1,
  4. Alison Wynn, researcher1,
  5. Vicky Hammersley, Trent Focus Research Network coordinator1,
  6. Carol Coupland, senior lecturer in medical statistics1,
  7. Rhydian Hapgood, MRC training fellow in health service research2,
  8. Peter Horsfield, clinical director, PRIMIS1,
  9. Sheila Teasdale, service director, PRIMIS1,
  10. Christine Johnson, lecturer in general practice1
  1. 1 Division of General Practice, Nottingham University, Nottingham NG7 2RD
  2. 2 Sheffield Centre for Integrated Genetics, Section of Public Health, ScHARR, University of Sheffield, Sheffield S1 4DA
  1. Correspondence to: J Hippisley-Cox
  • Accepted 17 March 2003


Objectives To determine whether paperless medical records contained less information than paper based medical records and whether that information was harder to retrieve.

Design Cross sectional study with review of medical records and interviews with general practitioners.

Setting 25 general practices in Trent region.

Participants 53 British general practitioners (25 using paperless records and 28 using paper based records) who each provided records of 10 consultations.

Main outcome measures Content of a sample of records and doctor recall of consultations for which paperless or paper based records had been made.

Results Compared with paper based records, more paperless records were fully understandable (89.2% v 69.9%, P=0.0001) and fully legible (100% v 64.3%, P < 0.0001). Paperless records were significantly more likely to have at least one diagnosis recorded (48.2% v 33.2%, P=0.05), to record that advice had been given (23.7% vs 10.7%, P=0.017), and, when a referral had been made, were more likely to contain details of the specialty (77.4% v 59.5%, P=0.03). When a prescription had been issued, paperless records were more likely to specify the drug dose (86.6% v 66.2%, P=0.005). Paperless records contained significantly more words, abbreviations, and symbols (P < 0.01 for all). At doctor interview, there was no difference between the groups for the proportion of patients or consultations that could be recalled. Doctors using paperless records were able to recall more advice given to patients (38.6% v 26.8%, P=0.03).

Conclusion We found no evidence to support our hypotheses that paperless records would be truncated and contain more local abbreviations; and that the absence of writing would decrease subsequent recall. Conversely we found that the paperless records compared favourably with manual records.


  • Embedded Image Definitions used in assessing medical records are listed in the appendix on

  • We thank the participating general practitioners and their staff for their help in conducting this study; and Ms Jane Allen for helping process the grant application.

  • Contributors MP had the original idea for the study. MP and JHC designed and wrote the protocol submitted for funding. JHC scored a sample of the interviews, supervised the data collection; undertook the data manipulation and analysis and primary interpretation. MP undertook the scoring of all the medical records. JHC and MP co-drafted the paper. RC undertook some of the general practitioner interviews, collected and entered data, helped administer the project; devised the coding scheme for the interviews and coded all the interviews and contributed to the interpretation of the findings. AW also undertook general practitioner interviews and contributed to the medical record scoring, background literature review and to project meetings. VH contributed practice recruitment, study design, development of scoring forms and interpretation of the findings. CC advised on the study design and data analysis. RH and CJ contributed to the development of the medical record scoring form and contributed to the interpretation. ST and PH were on the steering group and contributed to the design and interpretation of the findings. JHC is guarantor and accepts full responsibility for the study, had access to the data, and controlled the decision to publish.

  • Funding NHS ICT Research and Development Programme

  • Competing interests None declared.

  • Ethical approval Local research ethics committees in Nottinghamshire, Leicestershire, and Lincolnshire.

  • Accepted 17 March 2003
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