Data collection should be integrated with patient care

EDITOR,—The editorial on making routine data adequate to support clinical audit mentions the high quality of data from the St Mary's maternity information system,1 citing two recent papers on its validity.2 3 The editorial's authors, however, have missed the point about why this particular system has proved so successful. The basis of the system is that midwives enter the data themselves and then in turn use the system for practical purposes directly associated with patients' care—for example, it generates summaries and discharge letters. The system is thus integrally associated with patients' care and is not a separate task.

This experience strongly suggests that abandoning the normal practice of relegating the input of data to clerical staff results in better quality of data. This is both because the motivation of health care professionals is higher and, crucially, because of the reinforcing feedback loop involving the use of the information for patients' care.

The Department of Health has introduced an information management and technology strategy for the NHS in England, which has many positive features.4 Its potential Achilles' heel, however, is precisely this question of the quality of the data. Although it includes a data quality initiative, this is concerned mainly with administrative data (the postcode and codes for the provider, health authority, and general practitioner), the only clinical element being the code for the diagnosis.5 We suggest that a great deal could be learnt from the strengths and weaknesses of existing systems, especially successful ones like St Mary's maternity information system, and could then be used in the development of the future information technology for health care.