Objectives:To learn the attitudes of health professionals, health informaticians and information communication technology professionals to using data in electronic health records (eHRs) for performance feedback and professional development.Design: Qualitative research in a co-design framework. Health professionals' perceptions of the accessibility of data in eHRs, and barriers to and enablers of using these data in performance feedback and professional development were explored in co-design workshops. Audio recordings of the workshops were transcribed, de-identified, and thematically analysed.

Changes in healthcare, such as integrated care, the use of big data, electronic health records (EHRs), telemedicine, decision support systems and consumer empowerment, are impacting on the management of health information. Integrated care requires linked data; activity-based funding requires valid coding; EHRs require standards for documentation, retrieval and analysis; and decision support systems require standardised nomenclatures. The ethical oversight of how health-related information is used, as opposed to governance of its content, storage and communication, remains ill-defined. More fundamentally, the conceptual foundations of health information in terms of "diagnostic" constructs are creating limitations: Why should a medical diagnosis be privileged as the key descriptor of care, over disability or other aspects of the human experience? Who gets to say what matters, and how and by whom is that translated into meaningful information? These are important questions on which the health information management profession is well placed to lead. In this changing environment, threats and opportunities for the profession are presented and discussed. Highlighted is the need for leadership from the profession on the ethical use of health information.

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Hoyle, P 2017 integrated categories for integrated care -the importance of patient centred categories. Categorisation systems such as DRGs and ICD are fundamental to contemporary health services planning (what gets done where), funding (price and budgeting), operational management (performance metrics) and governance (which interests are recognised). A well implemented system makes a large difference: for example Activity Based Funding (ABF) has revolutionised the acute hospital sector, and driven major improvements in efficiency, management and governance All formal categorisation systems, by the very fact of distinguishing classes, create boundaries. When such systems are used normatively (for example, for budgeting) then those boundaries affect the behaviours of participants, whether clinician, system manager, funder or consumer. The result is that the inherent biases of such a system can become institutionalised, and boundaries risk becoming a border to defend, rather than an obstacle to be removed