Further changes are needed if the national care record service (NCRS) implementation is to succeed

While acknowledging the worth of the paper, there are significant issues on which there is literature that it fails to mention, or that are not treated as fully as they deserve to be. Our view is that unless implementation is accompanied by intensive formative evaluation including local flexibility in the development, procurement and implementation process - it is likely that it will continue to fall short of its objectives in both qualitative and quantitative terms. The complexity and rapid pace of change in patterns of care delivery and advances in technology highlight the need for evolutionary procurement and implementation processes. However, we are at one with the paper when it says that it is vital that the lessons from this project are learned, and taken forward into future implementations.