The world of medicine has lagged behind many other spheres of life in the exploitation of information technology. Hospitals which may bristle with magnetic resonance imaging scanners and phacoemulsification machines still rely on handwriting to enter clinical information into the notes. The conventional paper medical record, with all its disadvantages, still remains the central depository of medical information for patients in the UK National Health Service, and indeed throughout the world. There have been many applications of information technology (IT) in the NHS over recent years, including several spectacular failures.1 Most of these applications have been management driven, and hardly any have been successful in providing a real alternative to the paper record for use by doctors and other groups of clinicians in the secondary care sector. The majority of hospitals in the UK do not even have a computerised patient diagnostic index, which would allow basic questions about case mix to be answered. The primary care sector has fared better, and general practitioners have taken the lead in the clinical use of IT. The majority of general practices have computers in the consultation room, and many paperless practices currently exist.2 However, the development of computerised records in the acute hospital sector has been much more difficult, not least because of the increased range and complexity of the information that needs to be recorded.

The pressures for the adoption of an electronic patient record (EPR) in hospitals are now increasing. The process of clinical audit is currently time consuming and inefficient, with missing notes being a major impediment. Audit can be considered to be an algorithmic process. A series of well defined steps is carried out to collate and analyse data in order to answer a specific question. As such, the process is ideally suited for computerisation. However, …