A recent report by the Audit Commission has drawn attention to the standards of information on existing patient records.

In order to check the performance and finance of Primary Care Trusts, the Audit Commission does an annual check that the trusts’ bills match up with the patients’ original medical records. However, in an average of 8.1% of checks, the information on the original record was missing, illegible, incomplete or otherwise unusable.

During the debate on electronic patient records, the assumption has been that the information is out there in doctor’s surgeries and in hospital files, and that the new NHS IT programme is about changing the way we store this information for maximum benefit. However, for the potential benefits to be realized, it may be that as much attention is needed to the humans which update the files, as the computers which store them.

The move to electronic patient records has rightly heralded a number of calls for more training for NHS staff in the need for confidentiality. But much less has been said on improving accuracy and diligence in the recording of information in the first place. It wasn’t until October 2008 (6 years after the NHS IT programme began) that national standards were set on the structure and content of what should be recorded on a patient – and they have not yet been widely adopted.

Needless to say, there is a need for accurate patient records whether they are electronic or not. But the way we are using patient records is changing. Soon, when a doctor writes (or fails to write) an update on a patient’s record, it it not just her colleagues that are misled. Immediately it is added to a regional or national database, and may be accessed and acted upon in an emergency situation, or relied upon for research – the implications of mistakes and emissions are potentially much larger.

There is hope that typing will get over the problem of illegible handwriting, and clever computer programmes may be able to recognise and highlight inaccuracies. But the shift from paper to computer cannot help with missing or unusable information. In all, electronic patient records increase, not decrease the need for accuracy and diligence in record-keeping on the part of doctors and NHS staff.

While principally interested in the financial implications of these problems, the Audit Commission offers us a vital reminder of the GIGO principal of databases: no matter how good your system, if you’ve got Garbage data going In, you’ll have Garbage data coming Out.