The primary care electronic health record: who's righting the software?

The primary care electronic health record: who's righting the software? User Group (NVUG) in 2009. I also created a website on which I published my work in progress. 10 Before submitting this article for publication on 2 December 2010 I checked that the problems I describe below are still present in the software. RESULTS The EHR in our practice consists of: Contract+ (for QOF prompting), Docman (document management), ESCRO ([Enhanced Services Contracting Reporting Options], drug users), Microsoft Word (word processing), NHS24 encounter sheets (out-of-hours service), SCCRS ([Scottish Cervical Call-Recall System], smears), and Vision (core component of clinical system). There are national guidelines by the British Medical Below are guideline recommendations with examples of the deficiencies of the various systems. 'complete' and timely', 6 and convey 'narrative'. 6 Vision's Problem Pages list problems in alphabetical order without dates so there is no sense of chronology; other pages default to reverse chronology so that, especially for entries occupying more than one line, the narrative is lost. In Vision I'm unable to code fit frequency in the recommended Structured Data Area without a comment on aura, or to record 'currently teetotal' without selecting 'lifelong teetotal' or 'ex drinker'. Recording drug allergies in such a way as to trigger subsequent computerised warnings requires a precise Read Code although that's often unknown. In Vision, the field offered for date of last menstrual period becomes the date under which the note, with any free text, is listed in Journal View. In Vision, entering 'URTI' leads not to the most general ancestor code for URTI but to an end-node 'not otherwise specified' code which excludes all other types of URTI. In the Read Code hierarchy (currently Quarter 3 2010) 'male homosexuality' (E2200) is a child of 'sexual deviations or disorders' (E22). Entries made via Contract+ or ESCRO appear in Vision only after the patient's notes have been closed and reopened. In SCCRS a date for last menstrual period has to be entered even when it's unknown and I'm unable to combine a normal cervix appearance with a referral or an abnormal appearance with no referral. The EHR should avoid ambiguity, 'personal shorthand', 6 'meaningless phrases' and 'unnecessary abbreviations or jargon'. 8 In Vision, 'Hepatitis_B Stage: B Given Special Risk Group' means that a hepatitis B booster was given, although it could be misread as indicating a second immunisation. The Vision screen displays field names and data in …