ABSTRACT
In England and Wales only 5–15% of records have been converted to A4. Except for newly registered patients, good computer held data systems are extremely difficult to build without a good foundation of structured written data. Practices with A4 records will mostly have information entered in some kind of structure, which will make data retrieval much easier. A distant and vulnerable third priority may go to questions now classified as 'research', which have only become feasible with the advent of computerized data systems, but experience shows that this is more rhetoric than reality. The time required to extract data even from a structured written record ensures that this can rarely be done completely within even a generous consultation time of 10 minutes. Clinical habits, and the same time pressures, ensure that personal medical records are seldom reviewed thoroughly at other times. The main factor influencing choice of system is nearly always its short term cost.
