Essential prerequisites to the safe and effective widespread roll-out of e-working in healthcare

Health informatics applications are advocated in many setting in many countries, with convincing logic as to their likely benefits. But at present these visions are being projected to rapid enforced implementation without the necessary foundations of: empirical evidence; beta piloting or replication studies; appreciation of the magnitude of change for health professionals and systems in electronic working compared to paper-based systems. This is creating legal and ethical risks that are largely avoidable, all for lack of post-piloting study and adequate evidence-based preparation. Instead, roll-out should be facilitated by developing good implementation practice based on empirical evidence from beta sites, to cover the following aspects: evidence; evaluation; equipment; education; empowerment. e-Working is an essential technology to support modern healthcare delivery. It needs to be as evidence-based as any other health care technology, but at present policy and parsimony are forcing it to fall short of these standards, thus generating unethical risks. (C) 2005 Elsevier Ireland Ltd. All rights reserved.