Despite decades of research, health information systems have been characterised by cost over-runs, poor specifications and lack of user uptake. We propose an alternative approach to their design. By viewing health care as a process and quality as continuously seeking iterative improvements to processes, an objectoriented analysis reveals a class model, which supports quality assurance (QA). At the heart of the model is the ability to store actions for comparison with intentions. Measurement of the proportion of planned tasks that are executed provides a basis for identifying when to alter a process. We show that the model is able to represent medical and administrative procedures and argue that it forms an electronic record suitable for health care organisations. Were this record to become a standard, software could be developed close to the point of use, in harmony with the needs of stakeholders, so avoiding many criticisms of health information systems.