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Rees Moerman

Most "big box' efforts driven from a top-down-model yield very little in results. It is not surprising that these effort yield so little in real day-to-day terms for patients. PR efforts like the The Imagine Nation competition sponsored by HealthWays was less than spectacular. The problem isn't finding great ideas. It is the persistent and unimaginative execution with poorly supported resources for entrepreneurs. When combined with overly bureaucratic management stifling merchantable innovations the results are predictable ... failure.

These type of contest are typically 'beauty contests" for proposals, rather than viable change engines. We participated, and they were kind of fun, but meaningless as far as making any health improvement impact.

Canadians tend to distrust big changes in health care. We have been late adopters globally in health technology and we only take on new ideas after they have been well proven in other countries, usually decade or more after they have been embraced elsewhere.

It is a chronic and sad aspect of our national culture that we do so little to support our promising innovators and change agents. We seem to hope winning by default (which is what happened in our banking system). It didn't win because it was best, but the most timid in a manic world. However, that timidity does not work well in an aging and systemically atherosclerotic Medicare system.

Alan Brookstone

In an October 3 article in -, full electronic medical records predicted to still be 20 years away. While I think we still have some way to go, it is impossible to predict what is going to happen in 5 years, so 20 years is a stretch. However, there is a general sense that there is still a huge amount of work to and more importantly, attitudes, policies and processes to change.

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