Progress Opinion polls suggest that most medical professionals support the goal of an electronic record but have concerns about the NHS in England's strategy for building it.2 Many concerns arise from the national scale and mandatory nature of the national programme. This year the programme, run by a Department of Health agency called NHS Connecting for Health through private contractors, begins its main deployment phase. The government says that the care records service will be fully installed in the NHS by 2007, with health and social care information systems integrated by 2010. Liam Byrne, parliamentary under secretary of state for care services, spoke last month of “commendable progress” towards this aim.3 Achievements include the installation of a new broadband computer network, connected to 98% of general practices, as well as essential components of the care records service “spine.” The care records service will create electronic health records by combining central data about patients, including their identifying characteristics (the personal demographics service), administrative records, and important health alerts such as allergies, with summaries of care episodes drawn from local institution-based electronic patient records and, eventually, social care case files. Credit: ALAN E COBER/SIS/GETTY The system making this model possible is the care records service spine. It shares a metaphor with, and puts into practice, Microsoft chairman Bill Gates's vision of a “digital nervous system” connecting disparate healthcare databases. The production version of the spine, run by BT under a contract worth £620m (€904m; $1077m), went live in January. It is currently carrying demographic data to support “choose and book,” a system which allows patients to choose where their general practitioner refers them for secondary care, as well as some electronic prescriptions and whole patient records when patients transfer between general practices—so far, only if they use the same practice system. From August, if all goes well, summaries of clinical records will begin to be loaded on the spine.