Electronic patient records in primary care

Editor—There is a serious flaw in the design of the study by Hippisley-Cox et al on electronic patient records in primary care.¹ The authors say that they intended to differentiate between manual (all records kept on paper) and combination (part electronic and part paper record keeping) but actually differentiated between paperless (electronic) and paper based (combination or manual) records. The findings are therefore questionable.

For example, given that most general practitioners routinely prescribe electronically it is difficult to believe that paperless records were more likely to specify the drug dose unless Hippisley-Cox et al were reviewing only the paper based components of their paper based group, as opposed to the full record.

Additionally, Hippisley-Cox et al conclude that paperless records compare favourably with manual records. This is an extremely positive conclusion given that they specify one of the main reasons as to why general practitioners prefer to use paper based records during the consultation—diagrams. The lack of drawings observed in paperless records is surely due to the ineptness of electronic systems rather than because their value is not important? Although paperless records offer much from a medicolegal perspective, I wonder, from a patient perspective, how much more valuable that little drawing is? Can such drawings be disregarded so easily?

Finally, Hippisley-Cox et al say that the doctor-patient relationship may not be as personal as many suppose based on a textual analysis of references to specific patients. This is an erroneous observation given that doctors, like many of us, respond very heavily to visual cues as opposed to verbal recall.