Delivering the electronic healthcare record for the 21st century.

In spite of over four decades of research into Electronic Healthcare Record Systems, the penetration of records which incorporate more than simply basic information, into the working life of healthcare organisations is relatively small. This paper discusses some of the key impediments to progress including in particular, the lack of application of software engineering methodologies, the absence of usable standards, and the failure to acknowledge the impact of record systems on the healthcare system itself. However, Health Informatics researchers need to be preparing for the next generation of systems which will be triggered by the twin revolutions of the Internet and Genetic Medicine. This next generation of EHCR will be a longitudinal cradle-to-the-grave active record readily accessible and available via the Internet, and which will be linked to clinical protocols and guidelines to drive the delivery of healthcare to the individual citizen. Post-genomic research will unravel the link between genes, disease, treatment and the environment and this information will be used to promote health and individualise care. A number of key research issues are identified which need to be addressed in order to realise the delivery of the next generation of EHCR Systems.