Getting from A to C: lifecycle lessons for e-health deployment

The 35-year history of continuous development of hospital information systems and the current efforts to develop an electronic health record in outpatient settings suggest a lifecycle that must take place before electronic technology is adopted in the highly decentralised US healthcare system. This six-stage lifecycle, called the ABCs of change, involves Acceptance of the need for change, Alignment of the actors to fulfil that need, Breadboard development of the desired, integrated system, a Blueprint for the system to be commercialised, Configuration methods for adapting the system to individual provider and patient needs, and Capital sources for the desired change. This article shows how that six-stage model is relevant to understanding prior development attempts and how current efforts to bring electronic health records to small, primary-care practices follow it. We conclude that it is a useful model for insight and for future planning.