Why the EEPD?
EEPD Structure
Slide Shows
Publicity Flier
Help Please
New Words and Concepts
I.  Discussion Topics
 II.  Nightmares!
 III.  Datasets(>80)
 IV.  Data Resource
 V.  Logical Priority
VI.  Perinatal RIOs
VII.  Prognosis
VIII.  Signposts
IX.  Leaflet Lists & Links
 X.  Whiteboards
 XI.  Casenotes
XII. Proformas (inc. Gyn)
XIII. Computer Printouts
XIV. Care Paths
XV. S.IN.B.A.D s
XVI. Questionnaires
XVII. Codes
XVIII. Audit Benchmarking
XIX. Filofaxes Mnemonics
XX. Anecdotal Evidence
XXI. Training
XXII. Organisation
XXIII. Equipment
XXIV. Leaflets (inc. Gyn)
XXIV. Safe Motherhood
XXVI. Neonatology
XXVII. Gynaecology
A. Initiatives
B. Related WEB sites
C. Commercial IT
D. IT Contracts
E. IT Programs
F. Publications
G. Contacts
RISCOS essential
About R Fawdry
EPR News
Web Design



 Previous Page 

EEPD Volume 1. Discussion Documents.




A. Prologue

Regarding our Past Fantasies and our Present Chaos, especially in Acute Hospital Medicine (1 page) Past

A recent article in the Independent Newspaper entitled “Electronic Dreams” (14.7.2010) provides an interesting comment “We were promised  life of leisure thanks to hard-working robots . . . . But the android fantasy has largely been terminated.” yet another realisation that despite our hopes “Computer are not Magic” after all.  Electronic Dreams


B. Facing Reality in the Creation 

     of Acute Hospital/Community Electronic Patient Records


B00. Overviews (1 Page Each):

2005 Summary of Principles needed for making better use of IT in health care. (As prepared for the then Deputy Chief Medical Officer, Professor Aidan Halligan two weeks before he resigned!)



Some Key Words and Concepts relevant to Electronic Patient Records



My personal Experience of the NHS-IT over the past 30 years.  The Berlin Wall between centralised failures; and realistic progress based on local enthusiasm.



The great danger that the current emphasis mainly on collecting data will prove to be as damaging to good patient care as seems to be the case in police

Police overwhelmed by Red Tape


What it has often felt like to me Front Line Soldier

B01. Railways Network Rigidity: Not Road System Flexibility! 

(2 pages)

Computers are not magic. They are Flexible in Creation; but Rigid ever afterwards. 

Complex Analysable Electronic Patient Records are always like rigid Railway Networks;  and never like flexible Motorway Systems. 

But scores of invisible and Incompatible Railway Systems are now being created at massive public expense.

          Railways not Roads


  B02. The Workload and Cost of EPR Data Entry (16 pages)

On the importance of taking full account of the workload and cost of data entry in the selection of data items for Maternity Electronic Patient Records. The cost of Input and NOT just the value of potential output must dominate the selection of data



Appendix B & C

  Appendix D


B03.  Electronic Records in Maternity Care: 

Coping with Two Unavoidable Hybrids 

           and a Potentially infinite Workload. (9 pages)

Facing reality concerning the complexity of cost-effectively using computers to reduce human error and improve the quality of medical care.  Focusing on the essential need to give priority in the selection of structured data items to  “Individual Patient Care” (especially “Patient Encounter Assistance - iPEA”) rather than “Paralysis by Analysis” data items

Coping with Two unavoidable Hybrids; and a Potentially Infinite workload


B04. Destructive Undercurrents (In Preparation)

More detailed exploration of the destructive delusions which have crippled progress in NHS-IT for the past 30 years



B05. Essential Steps in the Creation of Electronic Patient Record Data Definitions 

           in Acute Hospital Medicine  (5 pages)

Creating EPRs


B06. The Mandatory Analysis for all EPR data items (14 pages)

Comments on the kind of mandatory analysis which is essential for every data item which is seriously proposed for inclusion in any Standard EPR National Data Resource Document

Mandatory Analysis


B07. Ethical Aspects of the use of hospital I.T. (4 pages)

1990:  Information technology and the White Paper: A Critique

Ethical Aspects


B08. Difficult Areas in Perinatal Computing; 

            with some Proposed Solutions (14 pages)

Difficult Areas


C. Electronic Patient Record Datasets - Especially Maternity

   C01. Credible Datasets (including a Score Sheet Proforma, 

and an Assessment of Current Perinatal datasets)

Almost all the senior NHS-IT “experts” that I have met still seem to believe that if only they could get the right group of experienced clinicians together on an occasional unpaid advisory committee they will finally be given the true and only correct clinical data-set in each speciality.  At the same time it seems that too many senior obstetricians still believe that computers are magic and that IT experts, with only occasional advice from clinician ought to be able, by themselves, to create viable clinical electronic records.

Both of these misconceptions have again and again made it impossible for there to be any real progress in the application of IT in Acute hospital medicine; and if we are to achieve a useful basis for the development of electronic as opposed to paper records certain simple criteria must be met.

When this idea was first suggested to me by Professor Richard Lilford, I thought that there would be only 4-5 such simple criteria; but computing is so complex that, in the end it turned out to be relatively easy to identify nearly 40 principles which need to be met if we are to achieve solid foundations for future progress. 

(Updated 9 August 2010)  

Credible Datasets


Using the criteria set out in the article above there follows a “Score” sheet to allow an easy assessment of any new attempt to create a perinatal dataset which makes a valuable contribution to the development of a standardised electronic patient record (Updated January 2010)

Assessment of Potential Perinatal Datasets


   C02. Phases & Modules

Full documentation of all the separate Phases & Modules required for the progressive installation of Maternity EPR Systems.  Going too fast into fantasy-land will continue to cripple staff morale and patient care. (Updated January 2010)

Phases in Creating a Maternity Computer System


   C03. Defining the Right Answer Options

A discussion concerning the slow task of finding the best set of answer options to complex question; not so few options as not to be useful; and not so many that data entry onto a computer database is too complicated to be practical.  (Updated January 2010)

Defining the best answer options


   C04. Proposals for Universal Minimum Birth Data-set

Proposals for the universal collection within 2 years of a Modified HES Maternity Tail consisting of only 25 data items set out in a way which reflects the flow-patterned design of a good maternity computer system. This dataset would be easily collectable using a simple two sided paper proforma. (Updated January 2010)

Minimum Universal Paper Dataset


Suggested Universal Minimum Birth Data set Paper Proforma

A paper proforma suggested for collecting the above where a computer terminal is not available. One side for the data which is the same even if multiple births; the other side for data which differs for each neonate if there has been a multiple birth.  11 items for the mother; 14 items for each baby.  (Updated January 2010)

Suggested Paper Proforma for Minimum Birth Dataset


   C05. Something for (Nearly) Nothing

Why multiple incompatible “Minimal Maternity Datasets” are impractical for maternity computer systems and why a large logical prioritisation Maternity and Neonatal Electronic Dataset is urgently needed and can be nationally introduced at virtually no cost.  (Updated January 2010)

Free Data


   C06. The “Resource Document” 

            and the “Logical Prioritisation” Dataset

Introduction to Volume 4 and 5


   C07. Guidelines for all New Datasets

New DataSets


D.  Reality in Acute Hospital Electronic Records


D01. Chips and Paper. 


OHPs  concerning the future of Acute Hospital Electronic Patient Records



D02.  Making Hospital Computing Work.   Why RIOs?; Why SINBADS? 

(In Preparation)




D03. Creating a R.I.O.  (Realistic Input/Output Opportunity)



D04. Basic Sites for RIOs in Maternity Care



D05. Critical Care Pathways, EPRs and RIOs.  (In Preparation)



D06. How to get the Best out of your EPR supplier.  (In Preparation)




E. Paper Pregnancy Notes, Printouts and Proformas


   E01. Basic Principles for the Design of all Medical Proformas1 page

Design of Medical Proformas


   E02. Comments on the Design of Maternent-held Pregnancy Notes 

10 pages

Pregnancy Health Records



Checklist for Hand-held Pregnancy Records


   E03. Creating a Complex Paper Proforma.

The Crucial Importance of Good Paper Proformas 

before trying to Computerise. (Unfinished) 3 pages so far

Introduction to EEPD Volume 12 (Paper Proformas)


   E04. ALERT System - MAINLY ANTENATAL (Including Sticky labels) 

   3 pages


If anyone knows a internet source of Coloured Paper Labels do let me know at editor@eepd.info

so that we can all benefit

ANAESTHETIC ALERT:  Problems which the Anaesthetists need to be aware of

Anaesthetic Alert LABELS (MSWord. 65 per A4 paper)


Anaesthetic Alert Proforma (pdf)


Anaesthetic Alert Proforma (MSWord Page 1)


Anaesthetic Alert Proforma (MSWord Page 2)


BABY ALERT:  Problems which the Paediatricians need to be aware of

Baby Alert LABELS (MSWord. 65 per A4 paper)


Baby Alert Proforma (pdf) 


Baby Alert Proforma (MSWord Page 1)


Baby Alert Proforma (MSWord Page 2)


CARE ALERT.  Social Problems which all Health Care Workers need to be aware of

Care Alert LABELS (MSWord. 65 per A4 paper)


Care Proforma (pdf)


Care Alert Proforma (MSWord Page 1)


HAZARD ALERT:  Bio-Hazard concerning Patients with HIV or Hepatitis.

   Biohazard Alert LABELS (MSWord. 65 per A4 paper)


Biohazard Alert Proforma (pdf)


MEDICAL ALERT:  To draw attention to Patients with Serious Medical Problems.

   Name Alert LABELS (MSWord. 65 per A4 paper)

www.fawdry.info/eepd/01_ess/e_paper/alerts/labels/AlertN.doc   ???

NAME ALERT:  Concerning Patients with Similar Names.

   Name Alert LABELS (MSWord. 65 per A4 paper)

www.fawdry.info/eepd/01_ess/e_paper/alerts/labels/AlertN.doc   ???

PHARMACY ALERT:  Especially any Regular Medication relevant to Breast Feeding

Pharmacy Alert LABELS (MSWord. 65 per A4 paper)


Pharmacy Alert Proforma (pdf)


Pharmacy Alert Proforma (MSWord Page 1)


Pharmacy Alert Proforma (MSWord Page 2)


STREPTOCOCCUS ALERT:  Confirmed Relevant Strep B infection.

Strep B Alert LABELS (MSWord. 65 per A4 paper)


Strep B  Alert Proforma (pdf)


TEARDROP Alert:  Past History of a Stillbirth or a Neonatal Death.

Teardrop Alert LABELS (MSWord. 65 per A4 paper)



Teardrop Alert Comment (pdf)


ALLERGY ALERT:  To draw attention to Patients with Serious Allergy Problems.

   Name Alert LABELS (MSWord. 65 per A4 paper)



Mixture of above labels for Community Midwives




As suggested in Discussion Document above ( A4 paper: 21 Labels)

Labels by Due Date Month for Labour Ward Ring-binder




F.  Signposts (Guidelines)


F01.  Towards an “Expert Computer System” (18 pages)



F02.  Outline of Detailed Documentation 

needed for Electronic Expert Suggestions (1 page)



G.  Codes, Presentem Groups and Care Pathways


G01.  Patients are like Countries not Cars



G02.  Presentem Groups in Gynaecology: 

A classification by Presenting Problem or Need



   Presentem Group Proforma for use in Gynaecology Outpatients



   Presentem Group Proforma for use in Gynaecology Outpatients



G03.  Presentems via Options to Outcomes (In Preparation)

www.fawdry.info/eepd/00_hom/DDNeed.pdf√   ???



G04.  Caustic Comments on Coding.  (In Preparation)

www.fawdry.info/eepd/00_hom/DDNeed.pdf√   ???



H.  Written Patient Information Leaflets


H01. Consent or Request

On the need for informed consent to be based, (as in Germany and Canada?)  on officially created Patient Information Leaflets specific to each major operation, with national standardisation regarding the incidence of “frequent” or “serious” complications.  And how a continuing move away from the nanny-state and towards greater personal responsibility should lead to “Requests Forms“ for surgery rather than our current patronising “Consent Forms“



H02 “Prescribing the Leaflet” Article

An updated version of an article originally published in Hospital Doctor on the Importance and Creation of Patient Information Leaflets.



H03 Three Complementary Sources

These three complementary sources consist: 1. Internet Printouts, 2. Properly Published Leaflets, 3. Computer Generated Prescribable Leaflets.  The advantages and disadvantages of each are discussed.  Why the third source of patient information is probably the most important.



H04 Problems with Alternative Sources

Single page summary of the above.



H05 Characteristics of Prescribable Computer Leaflets

Single Page Summary.



H06 Check List for Leaflet Creation

Check list for those creating Patient Information Leaflets



   H07 The Prescribable Leaflet Collection Introduction

An Introduction to the set of over 100 prescribable electronic text leaflets ready to be personalised locally.



H08 Full List of currently available Prescribable Leaflets

A full list of all the prescribable leaflets currently available via the EEPD: Volume XVIII. The Prescribable Leaflet Collection



H09.  Dust Collecting or Distributed

On the futility of continuing to create published, often coloured and professionally printed, leaflets which only reach a small proportion of those who need them; and which are far too often quite randomly available in frequently outdated versions in an over-filled untidy rack in the patients waiting room. A practical suggestion as to how this problem might best be overcome using 1-31 Concertina Files and a system of photocopying simple 1-2 page A4 leaflets long before VDUs and Printers become universally available.



 Presentem Group Proforma for use in Gynaecology Outpatients



H10.  Suggested Leaflet Sets (= “Refills Needed” proformas)

Suggested sets of the most common leaflets required at 21 different Gynae or Maternity Care Sites, for use with a comprehensive Concertina File Based System. One page draft list for each site to be stuck on the from of the file to show which leaflet is to be found in which numbered compartment.  Copies of the same page need to be kept in the back section of each file to be used to indicate which leaflets have run out and need to be replaced.



H11.  Distribution of “Photocopy Originals”

Assuming the use of different sets of photocopied A4 leaflets in 1-31 concertina files, this provides a “.pdf” table to tick of the sites which will need an “Original for Photocopying” of which leaflet.



H12.  Numbers of “Photocopy Originals”

Using the table above this provides a simple “.doc” list of leaflets with a space to document the total number of “Originals for Photocopying” which are needed for each leaflet.



H13.  Sticky Labels for use with the Concertina File Leaflet Distribution System 

(In Preparation)

“Original for Photocopying” labels




H14.  Using Analogies in Obstetrics and Gynaecology (In Preparation)

The many analogies which I have found to be useful in communicating with my patients.




J. Bees in Bonnet


J01.  Fallacies and Downright Lies 

            (Full article in Preparation)

Untruths found too often in Health Care Settings 


A. “You are uninsured for 6 weeks after a Caesarean Section! For the truth see 


              B. It is dangerous to use mobile phones in Petrol Stations, Aircraft and Hospitals.

As far as I have so far been able to find out there is no clear evidence for these beliefs.

Lots of people forget to turn their mobile phones off in such situations but there has been no evidence of an increase of petrol station fires, no aircraft accident has been documented as having been caused by mobile phones.  Indeed when escorting a patient on a small plane (5 people only), while taking off, the paramedic was using his personal mobile phone to arrange for an ambulance to meet us when we landed (although I am told that it is worth turning off the phone a) to stop irritating extra noises when the pilot is using his radio, and b) the mobile system gets confused by being able to interact with too many different phone masts)

And also, as far as I have heard, the chances of mobile phones interfering with medical devices is so small as to me non existent.  Such a possibility is certainly not a reasonable reason for banning the use of a mobile phone in the corridor or a side ward.  Naturally if used in an open ward one needs to be careful not to hold loud and long conversations to the irritation of other patients. The real reason for banning mobile phones is to push everyone into using the expensive hospital systems.

www.fawdry.info/eepd/00_hom/ItemNeed.pdf√   ???

J02.   Jargon or Simple English?  

             (Full article in Preparation)

“All Professions are a conspiracy against the Public!” (George Bernard Shaw)

Everywhere in the health service there is so much hot air talk about the need for better communication skills, yet everywhere we look, health care staff use jargon when simple English would take no longer and could so easily be substituted 

e.g. “4X / day” instead of “q.d.s.”, “Nocte” instead of “Nightly”,  “p.r.n.” instead of “When needed”, “Elective” instead of “Planned”, 

and the worst of all for professionally embedded patronising condescension doctor use regarding the reason patients need their help, the following: 

“Presenting Complaints” instead of “Presenting Problems/Needs”,  

Complaining of” instead of “Troubled by” etc.



W.   My many Whistle-blowing Attempts 

        (Historical Interest only)


2009 (Originally written in 1996)  -  

Still no official progress towards truly patient-centred Maternity NHS-IT



2004 -  Submission to the Deputy Chief Medical Officer

Short summary written in July 2004, at the request of Susan Bewley, Consultant Obstetrician, St.Thomas’ Hospital to present at a meeting at the Department of Health with Professor Aidan Halligan, at that time Deputy Chief Medical Officer. (When I had a meeting with him, I thought I was finally making progress towards the corridors of power but he resigned about two weeks later, partly in frustration at the IT chaos)



2003  - Submission to the House of Commons

The Collection of Data from Maternity Units and The Staffing Structure of Maternity Care Teams.  A personal memorandum on the exciting opportunities for radical re-thinking in both these fields.  As submitted to the Health Committee of the United Kingdom Parliament in February 2003



2002  - Letter giving reasons 

for the failure to create a National Hospital Record Project

Sad decision that 7 years of intensive work I felt that the National Maternity Record Project had so far lost it’s way as to force my resignation from the remains of the working party



2001 -  A Personal View of EPRs.

Written originally for Richard Taylor, MP for Kidderminster, (Retired Consultant Physician)



2001  - Snowdon is not Mount Everest

Reasons why the NHS-IT“MUMMIES” data modelling project failed to achieve anything useful and the NHS-IA “Maternity Care Data Project” Data Dictionary achieved so little compared with what was, and still is, urgently needed



2000  -  Why the NHS-IT Maternity Data Dictionary 

  and the MUMMIES project both failed?  

  What can be done to rescue them?

An analysis as to why the government had wasted about £500,000 of tax-payers money THREE on maternity IT projects which were of no use to anyone. Their failure is obvious from the fact that none is used in any current maternity IT system.   Indeed, as far as I know,  the only remaining copy of the outcome of the MUMMIES project seems to be a copy of the final report in paper held in my attic  This analysis was widely circulated but sadly totally ignored as being totally irrelevant to any functioning clinical computer system.



1996.  Towards a National Maternity Dataset

A Discussion Documentation on a set of Principles suggested for the creation of a National MINIMUM Maternity Data Set together with the proposal that there is also a need for a National STANDARD Maternity Data Set



X.  The Future: A Fantasy, a Nightmare or a Dream?


X01.  Comments on three possible futures.



Z. Web Links

Naturally there will often be other websites which may be relevant to this topic.  When this is so, it is intended that hyper-links should be created to supplement, or in some cases to replace, material available on the EEPD.  Such web-links are not always stable.  

It therefore seemed best keep a copy of such hyper-links at the end of each volume of the EEPD so that they can be more easily checked on a regular basis.

Links so far 

(An EEPD link does not imply endorsement of the contents of the link)

None yet documented for this Volume. 

Help needed

The creation of the EEPD is such a massive enterprise that links to other websites, both to commercial and non-profits making, are essential to it’s long term usefulness.  If you know of any potentially worthwhile links please let the editors know so that others may benefit.  Also if anyone worldwide has time to use search engines such as google to identify any such links do get in touch urgently.  See also www.fawdry.info/eepd/HelpEdit.pdf


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