The Good Electronic Health Record began when Dr. Alain Maskens, a Belgium Oncologist, wanted to collect data in primary care and analyse the records. The work took shape on an Apple II, requiring coding of terms to conserve space and translation of records. These two requirements led to an architecture with an individual file per patient and a sequence of coded terms which were displayed in the appropriate language - French or Dutch initially. Alain began to market this record in other countries in Europe and came to London in 1988.

The Department of General Practice at St. Bartholomew's Hospital in London had pioneered computerised primary care records in that country in the late 70's through the work of Professor Mal Salkind. Dr. Sam Heard, working in that unit since 1983, had established a collective of inner city practices using ParaDoc, a relational database, to aid patient care - Dr Dipak Kalra was a key member of this group. They were particular impressed with Alain's product - then called Health.one and trialed the record in four of the practices linked with ParaDoc. Problems soon became apparent due to the financial dependence in the UK on aggregated data. It was agreed to pursue a grant from AIM (Advanced Informatics in Medicine - an EC research organisation) to achieve a common health record architecture. The initial proposal in 1989 was not successful, though many links were forged with other key organisations in Europe.

In 1990, the team began meeting to make a new bid in the second round of AIM. Sam Heard, with the support of Alan Bennet from the local FHSA and Professor Lesley Southgate of the Department of General Practice, persuaded Professor David Ingram, the first Professor of Medical Informatics in the UK and based at St. Bartholomew's Hospital, to come to a planning meeting in Luxemburg. He agreed but made it quite clear he "would not be able to lead the project under any circumstances". Fortunately, on meeting other members of the team he quickly changed his mind. Other UK based collaborators were SmithKline Beecham, Dr Jo Milan from the Royal Marsden Hospital, Richard Dixon and Dr Penny Grubb from Hull University Department of Informatics and Dr. Stan Shepherd, then at Update Computers. Meanwhile, Alain Maskens had assembled France Telecom, Dr Daniel Mart from the Luxembourg Medical Association, the Health.one users group and Dr Christian Align from the French Red Cross Hospitals. A former colleague of Alain and Daniel, Dr Benoit Hap involved his software development company, C2V, and was a key member of the bid preparation. Drs Helder Machado and Jose Colado from Instituta Clinica Geral Zona Norte, Portugal were involved in the 1989 bid and remained staunch supporters. After a hectic round of grant preparation involving modem file transfers and all night vigils in Brussels and London the bid was submitted.

The first sign of possible success was a rather hostile visit to Professor Lesley Southgate and Sam Heard at St Bartholomew's by a leader of an alternative bid promising all sorts of collaborative opportunities with them if their bid was successful. His reaction to them expressing no interest in this made it clear that he had heard something about the GEHR proposal. We heard soon after. So began a three year project to develop a health record architecture for Europe, 5 million ECUs with many people involved. All felt the excitement mixed with an overwhelming sense of responsibility. The work was divided into three groups - a clinical group to determine the requirements was led by Sam Heard, an architecture group to develop the architectural description was led by Alain Maskens and a Systems group to deal with portability and comprehensiveness was led by Benoit Hap.

Much happened over the three years. Sam Heard returned to Australia but remained very involved - Dipak Kalra took over the clinical group. David Lloyd, the systems administrator at St Bartholomew's Hospital took over the systems group - Alain was always there. Key new faces were Tom Beale, a systems engineer working at the Marsden Hospital who developed the formal model of the architecture and Dr Sean Griffiths who developed many of the clinical requirements through practical research. The formidable array of deliverables of the project can be found at the CHIME website thanks to the dedication of David Lloyd.

Since then the group have been involved in many of the activities in Europe and Australia to develop a standard health record architecture. The CHIME group under David Ingram have become internationally recognised for their work in the area - Dipak Kalra and David Lloyd are still central to their efforts. They have been involved in the SYNAPSES project and are leading the EHRA-SupA project for AIM. SmithKline Beecham have invested in Health Data Management Partners and the Health.one product. Tom Beale and Sam Heard have been developing the Ocean Kernel, an implementation of GEHR as middleware for health applications. They have been working with Peter Schloeffel, David Rowed and others to get acceptance of this approach in Australia.