Health Information Management: Integrating Information Technology ...

26 STARTING POINTS
top-down programmes in place, trying to sell the benefits of ICT to the health
care organizations and the professionals within the NHS. These systems were
aimed at enhancing the use of data collection for managerial purposes, and
yielded very little enthusiasm from the professionals, as it was not clear what the
systems would bring to them. Furthermore, these initiatives were little
integrated, and were seen as mainly benefiting NHS bureaucracy.
CASE STUDY
Developing IT for primary care
The UK situation: software for collecting data for secondary purposes
The development of IT for GP practices took a somewhat different
trajectory than the development of IT for hospitals. In the UK GP practices
acted as independent businesses and therefore the GPs were not in the
same way targeted by the NHS initiatives of using computers for
management purposes. Still, however, the development of an EPR for
general practice was carried along by an interest in data recording for
secondary purposes like chronic disease management.
In the late 1970s, the Royal College of GPs published a report
suggesting that the Lloyd George record, the standard format of the paper
record, should be improved. The potential role of computers was not
mentioned. Local UK GPs, however, were already experimenting with
getting computers into their practices. In the years to follow a number of
small initiatives started up. Individual researchers, aiming at collecting
information for clinical databases, often drove these initiatives: in the early
days, researchers would collect disease registers on punched cards from GP
practices.
One of the biggest systems at that time, the VAMP system (Value
Added Medical Practice), was written and marketed by a GP. He involved
other GPs by paying visits to their practices, offering them his system for a
fee every year. Parallel to this he started and ran another company that
would buy the data they produced. This meant that basically the GPs were
offered a free system.
Another system that similarly introduced free computer schemes was the
Meditel system. Participating practices were provided with a multiuser
computer system on the condition that the general practitioners agreed to
collect and provide comprehensive data about morbidity, drug prescribing,
and side effects. The data were sold to the pharmaceutical industry, and
used for clinical trials (Benson 2002).
In the late 1980s VAMP and Meditel covered nearly 2,000 practices (20
per cent of all English practices). In spite of this the collection of
standardized data from general practices using the systems eventually
collapsed because the quality of the data collected was lower than had been