Primary care electronic health records: who is in control?

As a late adopter of electronic health records, apart from repeat prescribing, I was reluctant to leave my efficient paper practice notes that I controlled and wrote my patient’s narrative. It is now routine to record such contacts on the computer record but my eyes rarely lift from the keyboard. At the same time part of my mind is involved with the software set-tasks, often government driven, that need to be slavishly tackled in order to gain essential payment. I warned my past colleagues that this was the electronic hamster wheel of the medical primary care workload and they have nearly all retired early. I am still at the primary care coalface but this is due in part in trying to wrest some personal control of this electronic record in order to aid my patient care.

Here I refer to the recommendation to use clinical indications on all repeat prescriptions, which is a an excellent use of the repeat prescription electronic process, described in detail on my website.¹ The latest draft of the GMC guidelines on good prescribing recommends that all doctors should consider including such a process in their prescribing.² Smoking recording is another area that has needed revisiting and my smoking pack year calculator³ provides a smoking exposure dose on those ‘ever smokers’ so that smoking is searchable and potentially predictive. In addition I have developed some paediatric drug dosage calculators to aid my busy everyday work. These self-created additions have given me the much needed personal ‘locus of control’ of the electronic health record, but will scream in the face of industry standard setting and may make it impossible to transfer my detailed data reliably from GP system to system. Still I cherish my patient’s records in our small practice and a recent letter from a young consultant vascular surgeon unprompted said it all … ‘The computerised notes summary in your surgery is extremely impressive’.