David Ingram

Published On


Page Range

pp. 63–222


  • English

Print Length

160 pages

7. Health Care and Information Technology

Co-evolving Services

  • David Ingram (author)
This chapter tells a story of seventy-five years of coevolution that has connected the practice of health care with the science and technology of information. It moves from experience of health care in the remote village life of my childhood to that in global village life today. It explores decades of transition onto a new landscape of disciplines, professions and services, played out within rapidly changing social, economic and political contexts. This transition has been described as turning the world of health care upside down, from an Industrial Age to an Information Age—the former grouped around service providers and the latter with a more patient-centred focus. Changing means and opportunities for preventing and combating disease have succeeded in saving lives and extending lifespans, albeit with increased years of ageing life often spent living with chronic and incurable conditions. The contributions of good nutrition, clean environment, shelter, sense of community and security to longer lifespan and healthier lifestyle, understood now in greater detail, give pause for thought about the balance, continuity and governance of health care services. Three contrasting commentaries on this era of change are introduced—from industry, science and social commentators of the times.

With the arrival of new measurement and computational methods, spanning from genome to physiome science and to population level informatics and now machine intelligence, the Information Age has pressured health services with continually changing challenges, characterized by what has been described as ‘wicked problems’, the nature of which is discussed. Wholly new industries, providing products and services for diagnosis and treatment, many of these increasingly offered directly to citizens, have grown in scope and scale. In an era when powerful new treatments have come with increased risk of harm to patients, ethical and legal aspects of care services and their governance frameworks have come under increasing public and regulatory scrutiny. The changing scenes of education, assessment of competence to practice, accountability for care services, clinical risk, patient safety and research, are introduced, all dependent on the quality of relevant sources of information. This kaleidoscopic image of change sets the scene for discussion of the increasingly centre stage focus on information policy.


David Ingram


David Ingram’s career from 1967 spanned posts in industry, the NHS and University Medical Schools. After undergraduate physics at Oxford and several years in the medical engineering industry, he studied computer science and completed doctoral research on the mathematical modelling of biological systems, at University College London. His first academic post was at The Medical College of St Bartholomew’s Hospital, London, from 1975, where he was appointed Professor of Medical Informatics in 1990. From 1995-2011, he was the founding Director of the UCL Centre for Health Informatics and Multiprofessional Education (CHIME). David participated as partner and reviewer in UK Research Council, NHS, national e-Science and EU Health Informatics programmes and projects, including leading the EU GEHR Project (1991-94). This laid the foundations for the ISO-adopted openEHR specifications for a novel, vendor and technology neutral method for standardising the design of electronic health records, now being taken forward internationally by the openEHR.Foundation, of which he is the Founding President and Chairman of the Board of Governors. He is a founding Trustee of the OpenEyes Foundation, which is developing and marketing opensource software for ophthalmology, now providing the care record for 40% of UK patients. In retirement since 2010, he is focused on keeping well – eg by learning and using a new language, tracking lively grandchildren, following new physics, and learning to dance properly! Recently, he has become active in promoting a novel new technology to provide prescription glasses at very low cost for the developing world, where their lack causes extreme hardship.