Designing Clinical Systems

Abstract This chapter examines electronic health records (EHRs) as the central platform for modern, safe, and coordinated health and social care. It begins by outlining the essential characteristics of a well-designed EHR: longitudinal, integrated, comprehensive, standards-based, secure, and interoperable. The chapter then considers how EHR functionality supports clinical documentation and multidisciplinary workflows, illustrated through a case example of digitally enabled nursing care plans. It explores how structured and unstructured data are captured, stored, and applied to improve clinical safety and efficiency, and shows how predictive modelling, audit, and care planning can be strengthened through structured data entry and the use of medical terminology systems such as SNOMED CT. The discussion extends to the proactive capabilities of EHRs, including real-time clinical decision support alerts and data from integrated medical devices. Finally, it introduces the potential role of large language models in supporting automated documentation, summarisation, and conversational interactions within clinical records. The chapter highlights how well-designed systems can align technical functionality with professional needs, providing a foundation for safe and effective care while enabling future digital transformation.