Avoiding the 'dataset mentality'.

The Primary Health Care Specialist Group (PHCSG) has long held a view that the 'dataset mentality' apparent in some parts of the National Health Service (NHS) represents a barrier to the proper use of information systems directly to support clinicians and other frontline staff at the point of care. 1–3 However, the Group has been remiss in failing to explain properly why we take this position and the role that we see for datasets in the future development of NHS information systems. This editorial seeks to explain the problems that we see with the current approach to datasets and how this might be modified to avoid these difficulties. At the heart of our concern is a strongly held conviction that healthcare information systems should be designed primarily to support clinicians and frontline staff at the point of care. Information systems should be an integral part of the care process and must improve the experience for both care-giver and care-receiver, with system involvement being appropriate in the specific context of individual encounters. The specifications published so far for the NHS's proposed Integrated Care Records Service (ICRS) appear to show significant influence from the dataset development community and less input from the clinical community. 4 We are concerned that this approach is likely to encourage the development of systems that will fail to focus appropriately on supporting the care process. It is important that we do not fall into the trap of building systems whose purpose is, or appears to be, to populate specific datasets. If clinicians and other frontline staff find that new ICRS systems stretch or constrain their information recording in ways that interfere with the flow of the care process then they are likely not to use these more than they can avoid – and clinicians in particular are very good at avoiding management pressure to use systems. There is good evidence that frontline staff want to see the more effective use of information systems in the NHS and many would support the vision of the ICRS. In order to capture this enthusiasm it is necessary to deliver an ICRS that provides: secure, appropriate and timely access to all those concerned with the delivery of care to an individual to relevant parts of that individual's care records where and when needed to ensure the delivery of good quality and efficient care workflow management and decision support tools to guide …