What clinical database management system does the NHS need?

This discussion paper revisits the problem of the structure of the electronic patient record (EPR). It argues that by linking the design of the EPR to other legitimate data management activities in healthcare, such as accounting and administration, to provide a corporate database, serious compromises have been introduced into the EPR. These compromises do not allow the clinical data to be stored in their “natural” structure as understood and used by clinicians. This then limits their acceptability and usefulness. The requirements of an EPR are reviewed and it is suggested that an EPR structure which only seeks to reflect the structure of existing paper based records may be both usable by clinicians and programmable within a general purpose database management system