Architecture

Over-the-coffee-cup conversations that attempt to solve all the worlds problems (or at least the ones worth solving) are not uncommon.   Recently the theme of the centralised EHR has resulted in much caffeine intake.  A number of us have worked on large centralised EHRs and almost universally the feeling is one of "I wouldn't do it that way again".  Very few jurisdictions can afford to spend significantly on EHR programs and centralisation is a significant driver to cost bloat.  Furthermore, practical experience shows that centralisation drives complexity, and leads to less that successful implementations.  I've started to capture some of the ideas on other approaches in my blog (at http://wildfauve.blogspot.com/2010/02/what-centralised-ehr.html).  Grab a coffee and join the discussion.