To opt in or opt out of electronic patient records?

Editor—Watson's case that patients should have to opt out of national electronic care records is compelling.¹ In the Hampshire and Isle of Wight's successful records service, however, the key feature was the use of computer integration software (XML Graphnet), which provided a breakthrough in confidentiality while linking diverse and unrelated systems together.

The alternative method of trying to achieve joint working is to scrap all existing systems and force all services to use the same system. This approach was tested in Dorset as part of an NHS pilot scheme during 2001-3 by the Information Authority at the same time as the Hampshire scheme. It hit massive problems with data migration, confidentiality, and a revolt by general practitioners against the imposition of new software that did not work as well as their advanced surgery systems. This is the route chosen by Connecting for Health. The Dorset site recorded delays and escalating costs before abandoning rigid centralisation and adopting the same integration technology as Hampshire.

When we asked patients contacting the out of hours service for permission to look at their integrated record they universally agreed and were surprised that we could not already do this across the whole NHS.

After the National Audit Office report Lord Warner announced a review and proposal to look at the Veterans' Administration system in the United States and pilot sites in 2007.² The lessons are already here: Hampshire and Dorset piloted two methods of building the national system. Integration technology is the key to rapid progress. It is cost effective and rapidly reproducible, and it works.