Why is it difficult to achieve e-health systems at scale?

This paper examines some of the current challenges surrounding the implementation of information and communication technology systems to support the delivery of care within health services. These highly complex electronicinformation infrastructuressupport an increasingly broad array of functions and actors. They are being supplied in the UK National Health Service by commercial vendors as Commercial Off-The Shelf solutions. Vendors have struggled to developgenerification strategiesthat can accommodate the diverse practices and requirement of adopter organisations within their more-or-less standardised packages. At the same time there is enormous demand for improvements, coupled with a huge reservoir of potential innovations particularly where health practitioners interact with technology entrepreneurs. However, many outcomes of this bottom-up innovation process have struggled to be taken up more widely. As a result there has been markedly uneven progress in achieving radical visions that are being mapped out of how technology might transform healthcare. Drawing insights from Science and Technology Studies and related Information Systems research, the paper explores conceptual frameworks and methodologies that may help us better understand these challenges: the barriers to exploiting local innovations and taking them upon a wide basis and the tensions that need to be managed in the process. [ABSTRACT FROM PUBLISHER]