From experience it has proved difficult if not impossible to prevent clinician from duplicating data collection activities by sharing information. This is in part due to the professional responsibility felt by clinicians and their reluctance to rely on other people particularly in a climate where the possibility of litigation is real if mistakes are made. It would seem preferable to keep records at the individual level. Given changes in family structures over time a family record would prove unmanageable. Certainly there could be advantages in linking individuals to form groups as long as they can be dis-aggregated should the need arise.
Clinicians can only be accountable for the information that is entered in the first place.
We agree that there is potential for some checks and balances to be automated. However one area that must be addressed by the E.H.R is the fact that no information can be removed once it has been entered. Also, where information is amended the original entry must remain visible.