Health Information Management: Integrating Information Technology ...

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expected. Still, these schemes had a great impact on shaping further
developments in UK computing for primary care. An interviewee explains
how the computers used in the late 1980s were all set up for filling in data
for secondary purposes:
In the 1990s some GPs began using computers for administration.
That really came in with the fundholding, which came here in the
nineties, but the computer systems were set up before that. They
were set up with the idea that they would, you know, eventually
provide a way of recording all GP data. Diagnostic data, information
about tests as well as prescribing data and information about the
patients. So there were fields there for blood pressures, fields there
for putting in weights, fields there for putting in smoking habits…all
sorts of informational things.
One political initiative that pushed the development of an EPR along was
the fundholding enterprise. In the early 1990s under the Margaret Thatcher
government the funder-provider split was removed, and GPs were
requested to administer finances for their patients’ use of some secondary
care. GPs who wanted to become fundholders needed computer technology
to handle this. In addition, they had to report on these activities to the
health authorities, which similarly required increased registration and
information handling.
The National Service Frameworks programme, launched in 1998, set out
to ‘establish performance milestones’ (NSF website) against which
progress within an agreed area could be measured. To have the audit
programs work, GPs had to increasingly use diagnostic codes (Read codes)
when filling data into their EPRs. The coded information would
subsequently be transformed into publications that would outline
guidelines for treatment within specific areas (such as cancer, child care or
diabetes).
Within the last five years, GPs as well as voices within the government
have argued for a change of classification system. The Read codes, it is
argued, are too specific to be used for collecting high quality data for the
above-mentioned purposes. The NHS has looked towards the United States
for a classification system with a more hierarchical structure. Presently,
work is being done to integrate the SNOMED classification in the UK GPs
computer systems as the main classification for data registration.
The Dutch situation: the problem-oriented medical record in action
In the beginning of the 1980s, small informal groups of Dutch GPs
began to experiment with newly bought personal computers. Their first
initiatives were mainly directed at handling their financial administration
and the processing of bills. In 1985, the two major Dutch professional GP