Scaling up Health Informatics.

It took decades for the work of enlightened pioneers in biomedical informatics to reach the mainstream in hospitals and outpatient care. Initial successful projects, those that were able to demonstrate impact on quality and efficiency of care, relied on locally-developed systems, painstakingly tuned to the socio-technical specificities of their organizations. It took two additional decades to reach the industrial stage where systems could be purchased and deployed without having to be reinvented each time. The widespread – or looming failure of healthcare systems has increased the need for quality and timely information in order to better navigate in these troubled systems. Healthcare information technologies being considered by many to be a remedy, their providers are under pressure to deliver solutions, and implementers expected to make them work in challenging environments. Meanwhile, the democratization of the information society is bringing pervasive computing, connectivity and mobility, features and convenience that professionals and citizens are increasingly expecting to be able to use for healthcare and health management. These combined forces tend to generate excitement and creativity, but, as the regulation of healthcare information technology is still rather immature, they also lead to a flood of tools and systems, mostly independent from each other. At a time where coordination of care, economies of scale, and strengthening of health systems are needed, this is deleterious. In Uganda, for example [1], where dozens of eHealth and mHealth systems were being piloted or deployed without coordination, the government took the courageous decision to suspend the projects until they would be aligned to fit within the national eHealth strategy. This is, so far, a rather isolated example, but it illustrates the risks of “pilotitis” the multiplication of pilot projects, many of which are unable to scale up and sustain. In wealthier settings, regulators also struggle to steer towards coherent systems and their meaningful use. Indeed, key requirements are needed in order to deliver the promise of health informatics, as expressed in the IMIA vision: