Why e-health is so hard

Enrico Coiera
Med J Aust 2013; 198 (4): . || doi: 10.5694/mja13.10101
Published online: 4 March 2013

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”.

  • Centre for Health Informatics, Australian Institute of Health Innovation, University of New South Wales, Sydney, NSW.



This work is supported by the National Health and Medical Research Council Centre for Research Excellence in E-Health.

Competing interests:

No relevant disclosures.

  • 1. Coiera E, Hovenga EJ. Building a sustainable health system. Methods Inf Med 2007; 46 Suppl 1: 11-18.
  • 2. Bates DW, Gawande AA. Improving safety with information technology. N Engl J Med 2003; 348: 2526-2534.
  • 3. Black AD, Car J, Pagliari C, et al. The impact of eHealth on the quality and safety of health care: a systematic overview. PLoS Med 2011; 8 (1): e1000387.
  • 4. Magrabi F, Ong MS, Runciman W, Coiera E. An analysis of computer-related patient safety incidents to inform the development of a classification. J Am Med Inform Assoc 2010; 17: 663-670. doi: 10.1136/jamia.2009.002444.
  • 5. Greenhalgh T, Hinder S, Stramer K, et al. Adoption, non-adoption, and abandonment of a personal electronic health record: case study of HealthSpace. BMJ 2010; 341: c5814.
  • 6. Coiera E. Building a national health IT system from the middle out. J Am Med Inform Assoc 2009; 16: 271-273. doi: 10.1197/jamia.M3183.
  • 7. Gagnon MP, Desmartis M, Labrecque M, et al. Systematic review of factors influencing the adoption of information and communication technologies by healthcare professionals. J Med Syst 2012; 36: 241-277.
  • 8. Coiera E. Medical informatics. BMJ 1995; 310: 1381-1387.
  • 9. Jolly R. The e health revolution — easier said than done. Parliamentary Library Research Paper No. 3 2011-12. Canberra: Parliament of Australia, 2011.
  • 10. Smith SE, Drake LE, Harris JGB, et al. Clinical informatics: a workforce priority for 21st century healthcare. Aust Health Rev 2011; 35: 130-135. doi: 10.1071/AH10935.
  • 11. Shiell A, Hawe P, Gold L. Complex interventions or complex systems? Implications for health economic evaluation. BMJ 2008; 336: 1281-1283. doi: 10.1136/bmj.39569.510521.AD.
  • 12. Mohan MK, Bishop RO, Mallows JL. Effect of an electronic medical record information system on emergency department performance. Med J Aust 2013; 198: 201-204
  • 13. Coiera E. Why system inertia makes health reform so difficult. BMJ 2011; 342: d3693.
  • 14. Greenhalgh T, Russell J, Ashcroft RE, Parsons W. Why national eHealth programs need dead philosophers: Wittgensteinian reflections on policymakers’ reluctance to learn from history. Milbank Q 2011; 89: 533-563.
  • 15. Mandl KD, Kohane IS. Escaping the EHR trap — the future of health IT. N Engl J Med 2012; 366: 2240-2242. doi: 10.1056/NEJMp1203102.


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