The Guide to Health Informatics 3rd Edition

Dear [insert country name] Government,

E-health is hard. I think we can all agree on that by now. You have spent [insert currency] [insert number] billion on e-health programs of one form or another over the last decade, and no one knows better than you how hard it is to demonstrate that you are making a difference to the quality, safety or efficiency of health care.

You also know that so much of e-health needs to happen in the public domain that, irrespective of your desire to privatise the problem, you will end up holding the can for much of what happens. E-health is your responsibility, and your citizens will, rightly or wrongly, hold you accountable.

It is so hard to get good strategic advice on e-health. You recently commissioned [insert large international consultancy firm] to prepare a new national e-health strategy, and it didn’t come cheap at [insert currency] [insert number] million. In the end it told you nothing you didn’t really already know, but at least you can say you tried.

You also commissioned [insert large international consultancy firm] to prepare a business case to back up that strategy, and it didn’t come cheaply either at [insert currency] [insert number] million. The numbers they came up with were big enough to convince Treasury to fund the national strategy, but deep in your heart of hearts you know you’ll never see a fraction of the [insert currency] promised.

It’s also really hard to find organisations that can deliver nation-scale e-health to time, to budget and of a quality that the professions and the voters all agree it’s a good thing. You want the IT folks who build these systems to understand health care, its needs and challenges, deeply. Just because they can build a great payroll system or website does not qualify them to jump in and manage an e-health project. Do you remember how [insert large IT company] ended up crashing and burning when they took on the [insert now legendary e-health project disaster]? We can all agree that didn’t go as planned, and that you didn’t exactly enjoy the coverage in the press and social media.

What you really want firstly is impartial, cheap and informed expert advice because you are in the end driven to do the right thing. Given the heated and partisan nature of politics, that advice needs to come from safe and trusted individuals. That often means the advice comes from within the tent of government, or from paid consultancies where legal contracts and the promise of future work secure your trust. You also want the IT folks who build your systems to be deeply trained in the complexities of implementing systems for e-health. The health professions, and indeed the voters, also need to be sophisticated enough to understand how to use these systems, and their limitations. That’s going to maximise your chances of success, as well as blunt the uninformed chatter that so often derails otherwise good policy.

Our proposal is a simple one. We suggest you set aside 10% of the E-health budget to train the next generation of e-health designers, builders, and users. Use the funds to resource training programs at the Masters level for future e-health policy leaders, as well as system designers, builders and implementers. Let us provide incentives to include e-health in health profession training both at primary degree and for continuing education. Let us also invest in training the public in the safe and effective use of e-health. Investing in creating a critical mass of skilled people over 5 years will be your best insurance that, when you are again faced with e-health, you have a real chance of doing the right thing.

Given how little outcome you have had for your e-health investments over the last decade, and the harsh reality that little will change over the next, this is a chance to rewrite the script. Invest in people and skills, and you might find that with time e-health isn’t so hard after all.

[insert name of concerned citizen, NGO, or professional association]

[insert date]