What started out as a quest for a way of auditing free text gradually turned into a full electronic patient record system. The XML information system in Oswestry has been live for the past two years and contains half a million documents covering 50,000 patients. As elsewhere in the world the British National Health Service is under tremendous pressure from rising patient expectations and the inflationary pressures of technological medical advances. Failures of the system are often in the news whether these are related to human fallibility, criminal activity or simple inappropriate resource allocation. Medical data structured in XML allows examination of clinical activity with a power and scope never previously possible. Whilst a static data set can be indexed and searched in context using one of the many available SGML/XML aware systems dynamic data presents a greater challenge.