David Ingram

Published On


Page Range

pp. 225–350


  • English

Print Length

126 pages

8. Care Information as a Utility

What Is Needed and Why?

  • David Ingram (author)
This chapter is in three parts. The first explores what we have learned during the anarchy of transition of health care in the Information Age and why new ideas are needed. It emphasizes the organic nature of a care information utility, distinguishing it from a technical infrastructure. Organic, that is, in the sense of ‘relating to, or derived from living organisms’ and being adaptable, evolving and humanly-centred, to serve the needs of individual citizens for supportive health care services. In this regard, it draws an analogy with the forest ecosystem of the natural organic world, which was termed a ‘Wood Wide Web’ in a 1997 issue of Nature. It makes a parallel analogy with monetary ecosystems, discussing the relevance for health care information policy of the lessons drawn by Mervyn King, when writing about the world monetary system crisis of 2007–08.

The second part of the chapter celebrates pioneers I have known and worked with, who have made notable contributions in framing and implementing new ideas for information systems, achieving iterative and incremental advances towards meeting longstanding policy goals. The third part draws together future-facing perspectives of the changing patterns of knowledge and discipline, professional practice, education, research and global village community, which will form the landscape on which the care information utility evolves. It discusses the values and principles that should guide the development of the utility, the importance of a viable means for its standardization and the difficulties faced in achieving this.

The chapter concludes with a parenthetical reflection on what matters at the heart of the interconnected and currently fragmented domains of care information services, and the dilemmas they pose. This has been characterized in other contexts of public services as the need for a unifying change of perspective, from a focus on ‘What is the matter with you?’ to one of ‘What matters to you?’


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.