Data quality is an illusion

I read with interest the article by de Lusignan et al,¹ but I am more pessimistic about data and data quality allowing lives to be saved. My long experience as a full-time working GP tells me that records cannot be easily trusted.

Primary care computerised medical record (CMR) systems are not only complex, but their quality is also very variable. Not many GPs are interested in coding, not even when Quality and Outcomes Framework financial incentives are considered. Why? Simple: the general practice landscape has changed considerably over the last 10 years, and with an excessive workload and a reduced workforce, mainly made up of salaried GPs, whose income is not affected by targets, there is little or no appetite to use codes to the level needed to save lives, whether doing audits, or being part of research.

We use Problem Oriented Medical Records, and the Problem Lists arriving from other organisations are poor, full of duplications and synonyms with multiple irrelevant/out-of-date headers, while also lacking very important and relevant diagnoses.

We are supposed to link medications to diseases they are prescribed for, but there is a lack of commitment to doing this.

No doubt, bottom-up engagement is required if we are going to traverse the process of gathering more and more data and, at the same time, knowing less and less about our patients. CRMs are not seen as a powerful tool that can save lives but as an electronic notepad to scribble quite long and difficult-to-read accounts of the consultations. Unless attitudes change, and unless adequate training on the use and purpose of coding and Problem Lists are firmly embedded for newcomers to health care, the decline of the quality and relevance of the entries on the CRM will ratify them as what they are now in many places: garbage.