Michael Cross on Wales’s Individual Health Record system

In an echo of his predecessor John F Kennedy, Barack Obama has set his nation a massive technological challenge. In his first weekly presidential broadcast, he pledged: "We'll computerise the nation's health record in five years, saving billions of dollars and countless lives." Compared with Kennedy's 1961 ambition to send a man to the moon "before the decade is out", the goal of computerising health data may seem unheroic. However, in many ways it is a more daunting challenge. The moon programme was a triumph of human endeavour, but it was based on rock-solid principles: in 1961, scientists knew exactly where the moon would be nine years hence and roughly how they would go about getting there. Moving target Experts planning the computerised health record enjoy no such certainty. The "nation's health record" does not even exist as an entity today and it would be foolhardy to predict what it will look like in five years' time. For a lesson in how to manage the programme, Obama might do well to look across the Atlantic. Not to the NHS in England, where a £13bn-programme is this year reeling from its latest parliamentary battering, but to Wales. Earlier this month, Edwina Hart, the Welsh assembly's health minister, approved a plan to extend a system called the Individual Health Record (IHR) across the country. The decision comes seven years after the equivalent announcement in England, but no one need apologise for the delay. The Welsh IT team says that, by eschewing political deadlines and working with the NHS rather than trying to impose technology, it has created an electronic medical record that is not only more useful than its English equivalent but will cost a fraction of the price. The secret, says Gwyn Thomas, chief executive of the agency Informing Healthcare, is to listen to users. The contrast with the gung-ho English programme, now enervated by contractual rows and political grandstanding, is graphic. In the latest report, the chairman of the Commons public accounts committee, Edward Leigh MP, said: "Essential systems are late, or, when deployed, do not meet expectations of clinical staff; estimates of local costs are still unreliable; and many NHS staff remain unenthusiastic." Wales and England started off with the same goal - to make computerised medical records available where they are needed. However, the two countries went about it in wildly different ways. In England, the NHS took it for granted that the right technology was available and that staff were enthusiastic about adopting it. The central challenge was seen to be procuring the technology on the best terms, and implementing it to timetable

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Michael Cross on Wales's Individual Health Record system