so beguiling, so difficult
Electronic services are all around us. Millions of us use the internet, the mobile phone and the many services that they have spawned. Yet peer into any healthcare system and it will still be awash with paper. The technologies and services will be there in the form of email and pagers and sometimes clinical systems, but the relative lack of penetration is very striking.
This chapter argues that electronic services are now very appealing to politicians and policymakers, but they remain difficult to develop and implement in practice. In spite of the ubiquity of electronic services in our everyday lives, policymakers do not have convincing strategies to promote cost-effective solutions in healthcare settings. The next section sets out some of the reasons why IT and electronic services are attractive to politicians and policymakers. The following sections review the current state of implementation, offer a political explanation for this state of affairs and argue that a radically different approach to policymaking is required in order to develop an environment where electronic services can be properly integrated into the fabric of health and social care delivery.
As with many new technologies, IT has long been associated with a number of bold claims. In the 1970s and 1980s these claims focused on the capacity of IT to generate cash savings by reducing the numbers of staff needed for administrative tasks, and quality improvements that would be achieved through increased standardisation and reliability of data processing. In the 1990s the technologies changed and new claims came to the fore. One was that IT was a panacea for a range of