IDMR explored in a representative group of diseases, the design of a European patient record, structured on the decisions made by the doctors in caring for patients throughout their hospitalisation in each country of the European Community. Over 350 patients involving 6000 decisions were entered in the database. Working programs in FoxPro and Windows, a demo Apple program and an expert system in Prolog were delivered. The approach worked well. The catalogue of decisions and costs was illuminating. The complexity of a telematics patient record and the clinical work needed to produce it may be underestimated.