Modern medicine sometimes involves a number of parties individually contributing to a single patient's care in the community. There is likely to be overlap in their activities and the differing groups of various healthcare professionals (HCPs) who are each providing patient input can add up to a significant quantity of people and resources. The contributors could include a combination of primary and secondary care doctors, intermediate care, specialist and district nurses, social workers, pharmacists, physiotherapists, occupational therapists, palliative care teams to name just a few. To maximise input and to reduce overlap and improve efficiency, it is critical that all the HCPs effectively communicate with each other as well as the patient and their carers about their activities and decisions.

The problem is that it is likely that these HCPs are employed by different organisations and possibly work in geographically scattered sites, isolated from each other. It is equally possible that they may not know each other or may not even have met. So barriers to good communication are high but not insurmountable, after all we live in the modern communications era.

Despite this, we are still very paper based with forms and letters still flying to and fro and being captured in multiple medical records that are not always accessible, by different HCPs, all about the same patient. Ideally we should all be working from one electronic clinical record but then this raises the issue of who is ultimately responsible for it? Who alters the medication and who ultimately controls and manages this record, and how will security be maintained if there are many people accessing and changing it? It's a tricky area which means other ways may have to be generated until these issues are solved. This leads to a number of other alternative channels being explored and their success depends on the enthusiasm and persistence of the staff. It also depends on the skill and experience of the HCP, being aware what their colleague needs to know.

Using the telephone and leaving messages is a popular method but that leads to telephone tag as people miss each other or are not always available and messages are not always actioned in a timely manner. It also restricts the volume of data being transmitted and the quality of a message may be changed if a message is taken by someone else. Email is possible but we need to know all the relevant email addresses and we are not sure how often these email accounts will be accessed.

We still use letters such as referral letters from primary care to secondary care whilst clinic letters flow in the opposite direction. Apart from the time it takes to type these letters, reviewed by the author and being sent to their destination, not everyone with a legitimate interest can access it. In the middle of all this, is a patient whose care may be compromised by vital data and information not being shared quickly and effectively. Or worse, not being shared at all.

So what is the most efficient and effective method? Well I go back to a solution that may be difficult to implement and is likely to be expensive, as well as being a long-term solution. That is a proper national electronic medical record, which should be introduced from the ground upwards and involve all front-line clinical staff from the word go. In the current economic climate, this is unlikely to happen because of the high cost. Furthermore, public service IT projects have not always done well either due to cost overruns or impaired functionality or a combination of both. The best way to bring all the various clinical teams together under the one umbrella will be in a virtual environment of an electronic clinical record. Unfortunately I doubt if this will happen in the near future.