I had a problem with this book: despite having been in the business of electronics and healthcare for over two decades, I cannot imagine who would want to read it. Unless, of course, you were already in the field of organising electronic care pathways, and as such a rare breed. Its structure is not so much that of a book, but more a series of academic papers along the same lines tying together a developing subject of interest to specialists in the field. That doesn't at all mean the book is without merit or in any way inaccurate; it is simply that the subject itself is so impenetrable that it overwhelms any attempt to write about for the non-expert. That in turn calls into question just what is useful about care pathways themselves, and whether they have a place in the NHS of today, and this is where this book unintentionally opens up a large question about the provision of healthcare.

It is for this reason that if you are interested in the NHS, then it is well worth asking the library to get hold of a copy to skim. Don't try to read it though, or hot towels/cold compresses will be the order of the day; instead look at the style, content and format. Then consider who might ultimately have to put e-Pathways into operation, and you will realise the fundamental difficulty that this book portrays unknowingly well.

The book displays a good allegory for current NHS organisation. NHS structures are big, complex beasts which make normal business processes such as finance or industry look simple by comparison. Their working practices have evolved over a long time, have stood the test of time in most instances and, although plainly often old-fashioned and creaky, they are understood by those who provide care to patients. Crucially, therefore, they can be used consistently to produce results and don't of themselves provide an added overhead of administration.

Now while this sounds regressive, it's often forgotten by the "new" NHS that the prime function of managers and organisers is to provide support to care providers that is as far as possible invisible and unobtrusive. Their first rule should be like that of medicine: First, do no harm. To modify it for this application it would read: Never create extra work without very good reason. The "new" NHS habitually fails this test, and care pathways ("e" or not) are a prime example of such a failure. They add unproductive tasks to an already complicated process without gain for the carers.

So much for the particular, but what about the allegory? What has happened over the last decade is that management of the NHS has become an extension of the civil service. Those of you familiar with our marvellous civil service will know how it pursues its own agenda, and in the Health Service this clashes harshly with the care-givers' ethic and way of doing business. It is a sad and predictable fact that the power of the civil service eventually overwhelms the ethic of care, whatever good intentions are held by the carers. It should trouble us that care pathways promote that overwhelming tendency.

Care pathways as envisaged in this book represent the electronic version of a health-care process beloved of organisers (you can audit them), and cordially disliked by coal-face carers (they complicate an under-resourced job). That is the tension which the authors of this book introduce without realising it. Adding electronics makes e-Pathways very appealing to the programmer or systems mentality - but carers don't have that mentality, and it is they who are intended to feed e-Pathways.

The first rule of applying electronics to a business process is that you don't do it unless it is already beyond reproach in its present form. Only then can you hope to improve it by the addition of electronics. Care pathways are not at that stage in the NHS and may never get there. e-Pathways represent a triumph of research, systems, and civil service thinking over practical care: read this book and you will see why.

Dr Grant Kelly is a Chichester-based General Practitioner and IT Chair at the British Medical Association