Integrated patient records: another move towards quality for patients?

At a time when the health service is becoming aware of patients as the focus of its activity,'3 the organisation and structure of records have not developed to reflect this consciousness. Notes of medical care, nursing care, and other care generally remain separate, with a professional or treatment orientation rather than a patient focus. Why is the shift towards multidisciplinary, patient focused care not yet supported by integrated records which record information round the patient,4 even though successful operational examples exist?5 6 Traditionally, the medical record is episode focused, concentrating on the delivery of care during that episode, which may embrace a discrete illness or part of a period of ill health. It is provider based, not patient based, and during the lifetime of an individual patient it will emerge in many different forms in primary care, community care, and secondary care. Even in secondary care different records will be held by different provider units, and within one unit different records will be generated by doctors, nurses, paramedical professionals, and specialist departments. The patient is disadvantaged because there is no complete record of clinical history or treatment received and because care is given without full knowledge of the patient's history. The health service reforms, though promoting multidisciplinary working through clinical teams and directorates, may reduce record sharing between care providers. Moreover, the move towards consultant episodes may fragment the record even further.7 On the other hand, the development of a consumer oriented society in parallel with the commercialization of health provision is raising awareness of health matters and strengthening the public sense of responsibility towards health. Thus individuals are encouraged to participate in health promotion and health care planning and provision. If this is to be effective, and if it is to be matched by an equal commitment by professionals to considering the whole person, data on a patient's health and disease need to be held in a record which is individual but composite, relevant, appropriate, and useful to that patient.