History of the TDS medical information system

Over many years, general practice computing has prospered, whereas hospital clinical computing has not. Differences in leadership and economic incentives partially explain this. In general practice the government and the profession worked together to remove barriers and provide incentives to computerisation. In hospitals the opposite happened. Changes are needed to provide professional leadership and economic incentives in both primary and secondary sectors. An early step would be to establish united stakeholder organisations for clinical users and information technology professionals in health care, covering all aspects of healthcare computing The NHS is now planning to deploy integrated patient record systems across both primary and secondary care. The examples of Kaiser Permanente and the Veterans Administration suggest that such systems may play a critical part in improving effectiveness and efficiency. However, such a project faces several technical obstacles, mainly associated with scalability. It is much easier to computerise small general practices than large complex hospitals, let alone provide integrated services across an organisation as large as the NHS. These technical issues—which include patient record architecture, terminology, interoperability standards, security, and developments in computer technology—are the subject of my second article.