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Increasingly, the ability of electronic health records to improve the efficiency, safety and quality of care compared with paper-based systems is being recognised across the health sector [ 1 ]. Increased focus on "seamless delivery of care", particularly for those with complex care needs, has highlighted the requirement for improved information exchange between health service providers. Electronic records and transmission of personal health information can be powerful tools for linking the fragmented information that exists between services and allow providers immediate access to essential clinical information.
As reported in the 2001 WAVE Report ("Working to Add Value through E-information"): [ 2 ]
Integrated information systems mean providers have access to all of the patient’s appropriate medical history. Sound information reduces risk, guides quality improvement and supports research on better health care practice. Providers will have faster access to accurate information about services patients have already received, enabling more appropriate treatments; laboratory tests and x-rays will be duplicated less often; and the system will signal if combinations of prescribed drugs have harmful interactions. And planners and funders will be able to identify more easily where resources are most needed and will be able to recognise (and, therefore, reward) good practice.
This improved knowledge base will not only improve the quality of care but should reduce the possibility of medical misadventure. Efficient use of information will reduce the cost of delivering health care, making it possible to offer more services.
This edition of Health Care and Informatics Review Online considers the role of electronic health records in promoting quality of care, with a focus on the primary health care sector.
The edition opens with "A review of computerised information technology systems in general practice medicine" from Rebecca Didham and Isobel Martin, Department of General Practice, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand. Didham and Martin, review the current state of technology use with respect to electronic health records in general practice in New Zealand, Australia, the UK, Canada and the US. In doing so, they highlight what has been a paucity of data on the state of practice management information technology (IT) in individual countries, but that representative data are now beginning to emerge.
Didham and Martin note that the backbone for the use of IT in health care is already in place in New Zealand and highlight the requirement for refinement of these systems and for compatibility and standardisation between system users. The paper includes recommendations for developing practice information management in New Zealand health care for the next decade.
Ken Leech, Information Systems Manager, ProCare Health Limited, Auckland, New Zealand, presents an argument that the comprehensive electronic health record as it is typically portrayed is unlikely to be practically achieved. Creating and managing an electronic health record that holds all medical information about a patient available to all clinicians is, in his view, "quite simply, too hard".
His alternative proposal is for a series of more narrowly scoped "stepping-stone" projects in electronic record management that target specific patients, specific clinical information and specific clinicians and that work within the applications already used by clinicians.
Leech is a strong advocate for ownership of such projects by primary care itself, rather than the weaker option of consultation or other forms of engagement. Although governed and led by primary health care, Leech sees a ready extension of the concept to include other providers involved in a patient’s routine care.
In "The Electronic Health Record in New Zealand", Karolyn Kerr, Advisor, Health Sector Information and Technology, New Zealand Ministry of Health presents a personal view outlining New Zealand’s current capability to develop comprehensive electronic health records and relates this capability to the current international position.
Kerr notes that New Zealand’s new focus on seamless delivery of health care between primary and secondary providers, and increasing pressure for individuals to take responsibility for their own health status, are driving the requirements from both clinicians and consumers for access to up-to-date patient information and the latest health research.
Kerr offers a definition of electronic health records and outlines critical components of electronic health records and the building blocks required to support them. In this she addresses the key areas of standards, infrastructure, information and change management.
Kerr reviews the possible impact of electronic health records highlighting benefits for both health service providers and users. Importantly, Kerr makes reference to the health service planning benefits that derive from the capability to collect unit level information about patients that can be aggregated at local, regional and national levels as required, and other benefits such as the ability to undertake health outcomes research, targeted regional and national health promotion programmes, clinician performance assessment and national policy development. 
References
1. National Electronic Health Records Taskforce Issues Paper. A National Approach to Electronic Health Records for Australia. March 2000
2. Ministry of Health. From Strategy to Reality: The WAVE Project. October 2001.
