The reference is of course to Swift: Gulliver's Travels, and not to the difference in memory architecture of PCs and Macintoshes.

Notes can be presented on computer screens either with the most recent at the top, and the least recent at the bottom, or the other way around. 1

Those who see the notes as a single narrative sequence may well plump for the Exeter System, (which regrettably falls from it's model by having the summary at the beginning of the notes not the end, and by presenting the user with the earliest note instead of the end of the sequence but there is another story)

Those who see the notes as representing a number of individual episodes, not really connected, may favour Vamp Medical ("might have favoured" is a more accurate tense I suppose) or if rather more sophisticated they would plump for GP Plus, or Surgery Manager (after it lost its journal view).

The user who sees life as a chain of intertwined but discrete (or at least separate) problems chooses Meditel System 5, which in clever fashion managed to add a journal view to suit the "narrative hooked", and then load the use of this with disapproval. ( = Unlinked notes!)

The clever presentation of "episodes of care" in Vamp ViSion is a step in the right direction for some people who have previously not had a demonstration of this approach.

Doctors (or bean counters) who feel that the notes don't belong on the computer won't understand this. To them the computer record is a set of Cope-Chat cards, in separate boxes (like AMC 2000). They may even have chosen AMC 2000 and not understand what the fuss is about, although the next paragraph will bear upon them.

So what is the result for each of these users, of a supplier buying the supplier of their system, pausing development, and pushing them toward a solution which suited a different type of people when it was specified, designed and developed?

Not good.

Designing one system so that it gives the different views "personalities" of the data to each different sort of doctor would be very very clever, and I see no evidence it has been accomplished. Again, I return to my recurring thesis, which is that almost everything about the way in which we devised, developed, controlled, bought and administer our various computer systems is wrong.

To give one more example of a sort of user (not necessarily a doctor, your Practice manager may understand this one much better) - consider the person who sees the activity of the Practice as a sequence of individual actions, which affect different patients nearly simultaneously, but which can and should be seen as a single sequence or list, and searched and manipulated as such. They will be owners of an Ambridge system.

Correctng errors on Ambridge is easier than most systems, it was designed that way, by dialogue with people of that sort who wanted it that way.

Doctors are ill-served by commercially inspired mergers of companies in order to gain market share. Meditel are guilty of this in respect of AMC users, Microsolutions vice GP Plus users, and Reuters vice Microsolutions SM and GP + users. LK Global are attracting adverse comment from users of Amsys and Genisyst software, after taking these companies over.

I know little of Update, Brand and so on so I will forbear to comment.

Much of this of course would be far less important if the funding of these systems followed either rational public service principles, or standard commercial ones. If when a GP's supplier was taken over by an inimical force the GP could either make the investment in a sensible change to another system, and recoup it from their fees - or they could have their re-equipment funded by the NHS at reasonable levels, some good could come out of the takeovers. Conversely, if the users could afford to pay for systems to be developed properly, perhaps we would have that clever multiple-personality system I referred to above - and it would have been snapped up by Practices where one partner is of one sort, another of another and a third of a third.

But they havn't.