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Special Issue Integrated care records: problems and solutions

Integrated services for health and social care are now a priority in the UK and elsewhere. Not surprisingly, the implementation of such service improvements focus on the Integrated Care Record (ICR) and its promise of rapid, location-independent access to consolidated patient information. In the UK, for example, the NHS Care Records programme (NHScrs), which is part of a larger National Programme for IT (NPfIT), seeks to develop an infrastructure for shared records through a central records ‘spine’ and local service provider contracts. The patchy success record of similar projects in the past makes it clear that the issues surrounding the realisation of the ICR vision are numerous and often complex. A number of these issues were explored at workshop on Integrated Care Records held in Edinburgh on the 11th and 12th of December, 2003. This special issue of the Health Informatics Journal draws on some of the papers presented and the themes that emerged. The focus is on sharing research and practical experience of ICR projects in action. The recent announcement that the National Audit Office is to investigate NPfIT makes it especially timely. In the opening paper, Matthew Jones sets the scene for NHScrs with an overview of development of the electronic patient record concept and of past NHS implementation efforts in this area. Jones summarises a number of basic lessons from past problems but casts doubt on whether the current NHS ICR programme has taken them on board. Picking up some of the issues raised in the first paper, Marilyn Kirshbaum’s paper gives us a snapshot of current attitudes among healthcare professionals at two NHS acute hospitals towards computers and electronic patient records. While Kirshbaum notes that any generalisation of these results should be attempted with caution, she reminds us of the importance in IT projects of training users and of attending to organisational needs and to the management of change. She also recommends procedures for monitoring project progress and the impact on staff and work practices.