I worked directly (as architect and programmer too) on one of the largest e-Record efforts in the USA. It was a travesty of waste, incompetence in management, disjoint 'silo' groups programming this or that part. Then I left the project. I got hired back 1.5 years later to the same project, and NOTHING had happened. Management on the project had such intense navel-gazing. They would have big meetings to congratulate each other on their wonderful leading-edge project. Money flowed like water and nothing happened. A year after that I had lunch with the engineers there. Still nothing had gotten done. These medical e-Record projects are about all about using govt. money, and not a bit about getting anything done. None of the leadership (both technical and managerial) had any clue how to get software written that might actually get used. Lots of theory, no application. You gotta love those Medical Informatics Phds. The basic problem is that the medical record problem is so huge, and the need for automation so great, that money get's thrown at the problem. But like most govt. projects, there is no actual responsibility or market feedback.