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Why e-health is so hard

We need to respect the basic rules of informatics and invest in e-health expertise

Medicine holds dominion in the microcosm of molecules and genes. It is in the macrocosm of people and organisations where things seem to fall apart. Modern health care appears unsustainable in its current form,1 and information technology is increasingly seen as a major intervention that can drive “reform”.

Evidence for e-health’s potential to improve the safety and quality of care grows,2 but remains patchy.3 The long list of disappointments and failures,4,5 locally and internationally, is also hard to ignore. There is a real dissonance in the discourse between what research evidence tells us is possible and what often happens with large-scale e-health projects in practice.6

The literature repeatedly describes basic “rules of informatics” for implementation success: the need for stakeholder engagement, culture change, user training, slow and considered implementation,…