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The naked truth — Bewley et al. 341 —

13 October, 2010 (22:03) | EPR, Initiatives, workload | By: Helga Perry

The naked truth — Bewley et al. 341 —

(at least we can spell Grant’s name correctly on this reprinting of our letter)

The naked truth

  1. Susan Bewley, consultant obstetrician1,
  2. Rupert Fawdry, consultant obstetrician and gynaecologist 2,
  3. Grant Cumming, consultant obstetrician and gynaecologist 3,
  4. Helga Perry, electronic systems and resources librarian4

+Author Affiliations

  1. 1St Thomas’ Hospital, King’s Health Partners, London SE1 7EH, UK

  2. 2Leighton Buzzard, Bedfordshire, UK

  3. 3Dr Gray’s Hospital, Elgin, UK

  4. 4University Hospitals Coventry and Warwickshire NHS Trust, UK

Despite the expense, frustration, and slow implementation of electronic health records, hospital clinicians still believe in “imagined, ideal electronic records systems.”1 But is this a case of an emperor with no clothes? There is little hard evidence of benefits in patient outcome, and confidentiality concerns remain.2The rigidity of analysable electronic records has been underestimated. Terminology and flow patterning of electronic questions are not standardised, yet every time data are duplicated, the human resources available for direct patient care are reduced.

In 30 years’ experience of computerised maternity systems we have seen little progress. The most recent NHS-IT initiative, the national maternity services dataset,3 does not aim to improve patient care or reduce staff workload. It suggests that the purpose of electronically documenting over 400 data items for every pregnancy in the UK is for secondary management indications. This ignores the complexity of maternity software4; the minimal interconnectivity between different suppliers, and even within hospitals; and the cost and workload of implementing these decisions.

Websites like the Electronic Encyclopaedia of Perinatal Data ( provide an opportunity to examine and debate the value of each item of medical data (paper and electronic). Harnessing the expertise of clinicians worldwide using “electronic communities of practice” may help overcome the problems encountered with electronic records.5


Cite this as: BMJ 2010;341:c5637


  • Competing interests: RF is the originator of the Electronic Encyclopaedia of Perinatal Data (EEPD). He has served on virtually all UK national maternity notes and IT projects since 1980. From 1990 to 2001 he was reimbursed by Protos (now iSoft Evolution) for the use of his expert medical knowledge. He has had no commercial connection with them, or any other company, since 2001. HP is a volunteer coeditor of EEPD sections.


  1. Robertson A, Cresswell K, Takian A, Petrakaki D, Crowe S, Cornford T, et al. Implementation and adoption of nationwide electronic health records in secondary care in England: qualitative analysis of interim results from a prospective national evaluation. BMJ 2010;341:c4564. (1 September.)
  2. Delamothe T. How the internet’s unmanageability might play out. BMJ2010;341:c5190.
  3. Information Centre for Health and Social Care. Maternity services data set downloads.
  4. Fawdry R. Difficult areas of perinatal computing. Electronic Encyclopaedia of Perinatal Data,
  5. Ho K, Jarvis-Selinger S, Norman CD, Li LC, Olatunbosun T, Cressman C, et al. Electronic communities of practice: guidelines from a project. J Contin Educ Health Prof2010;30:139-43.
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Comment from Helga Perry
Time October 15, 2010 at 00:17

BMJ Rapid Response by Dr. Gerhard Holt

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