The 'Health Career' - records and symmetry breaking: Admin vs Clinical needs?

In my nursing career to date and over the past 18 months I've been involved in some complex clinical cases involving profound physical, mental and social aspects of care.

Such complexity given the rise of long-term chronic medical conditions, multiple diagnoses and an ageing population is not uncommon. What is more remarkable is simultaneously reading on the records management and other informatics mail lists questions regarding the retention of specific types records within health care, social care, schools and the human resource departments of other organisational settings.

From the perspective of Hodges' model and the notion of a health career you wonder about the efficiency of administration - and legislation - versus the potential future utility of 'archived' clinical records. Clinical records from 20 years ago and less have frequently been destroyed and you are left to consider the possible relevance of that information to the care delivered in the here and now? This is particularly acute for reasons of the following:

• the increase in dementia and an individual's capacity to account for their past care;
• the increase in fractured family histories;
• the likelihood of significant past care episodes and medical events relevant to future episodes: 1) cancers; 2) psychological problems; 3) negative life experiences;
• the use of the medical record (health career) to inform someone's life story (and not just as a 'therapeutic intervention').

Is there an argument for a re-appraisal of retention schedules? Factors to consider might include:

• the shift to digital collection, storage, archiving and ever improving retrieval technologies;
• the use of semantic search - and intelligent (context - discipline-based) applications;
• the ability of the individual to decide on the longevity of their records;
• the advice of specific patient groups - Alzheimer's; Multiple Sclerosis; HIV / Aids...;
• the transition of an individual record to an item of historical interest;
• the ongoing emphasis upon collaborative care, self-care and personal health records;
• Archiving - shift from paper-centric to inclusion of digital media?

What do you think?

Additional links:

DoH Records Management - Information Policy

DoH (2006) Records management: NHS code of practice

Personal Health Record