Very interesting...I will contribute something of a counter-point from this side of the pond. The US government has been funding health IT pretty heavily of late. The Veterans hospital system has a very effective and well-liked EHR system called VistA that is currently being revamped for use in other government facilities. PriceWaterhouse did an analysis a while back and found it very cost effective. In terms of public hospitals, most of the work is being done by the Community Health Centers (safety net care providers, like healthcare for the homeless, etc.). They can get grants for implementation, and are of course generally strapped for cash so the idea of these systems generating savings (less staff needed) and increasing revenue (increased productivity and better billing), both of which have turned out to be very real, are quite attractive. In my work, we just did site visits to the real leader of the pack, a network of independent centers who've banded together and are in the process of going completely paperless. Largely because of their size, they were able to bring WebMD to the table and essentially co-design a comprehensive EHR system: prescription writing (with allergy and interactions monitoring), digitized lab submission, retrieval and approval, clinical guidelines reminders (Mrs. X hasn't had a mammogram this year, etc.), appointments, and a chart writer. The providers have all come to really love the system, and carry their tablet PCs everywhere. Security is extensive, but nobody complained about it. The real issues now are specialization and standardization: the WebMD product works great for the above network, but has been a disaster elsewhere, when centers have been unable to do as much customization; everybody needs a common set of codes, like HL7, to communicate between providers and payers. But the benefits of these systems, in so early in development, are incredible: you see real decreases in medication errors, improved follow-up, better chronic disease monitoring, etc. I can't wait till it's really happening.