Recently, in a publication in the well-circulated magazine for medical professionals in The Netherlands “Medisch Contact”, the Dutch Ministry of Health, Welfare and Sports was criticized over their plans for the national Electronic Health Record. The authors accuse the Ministry of restricting innovation “whilst Web 3.0 is forthcoming”.
National programs for the introduction and use of Electronic Health Records are usually at the center of attention for professionals and politicians alike. The nature of these programs makes them vulnerable to a diversity of criticisms. The fact that a long-term perspective is taken, with high ambitions and serious impacts, often calls for lengthy procedures in terms of policy setting, stakeholder buy-in, open tendering, and specific legislation. One of the major trade-offs to be made is on the technological dimension: how to balance between state-of-the-art and the current installed base of systems and their legacy technology. The fact that the architecture is usually designed at the beginning of the long-running program makes it an easy target for arguments that it doesn’t keep up with current technology.
Communication is key to refuting these arguments and keeping the program in perspective. It helps when clear governing mechanisms are in place for architecture development and the renewal of parts of the specifications. Such mechanisms can be designed to achieve the necessary balance between proven technology and current innovations, and to keep that balance in place over the lifetime of the EHR infrastructure. Leaning too much towards innovation will call for major redesign during a project that is already hard to really get off the ground. The old adagium – Perfection kills Progress – is applicable here as well. We would like to hear your experiences in coping with this dilemma.