Intended for healthcare professionals

Education And Debate

Four rules for the reinvention of health care

BMJ 2004; 328 doi: (Published 13 May 2004) Cite this as: BMJ 2004;328:1197
  1. Enrico Coiera, professor (
  1. Centre for Health Informatics, University of New South Wales, Sydney, NSW 2055, Australia
  • Accepted 11 March 2004

If health care is to evolve at a pace that will meet the needs of society it will need to embrace this science of sociotechnical design, but ultimately it is our culture's beliefs and values that shape what we will create and what we dream

Futurists might like to speculate on what the health services of 2020 look like. The world may be such that as a clinician you work in flexible virtual teams and some of your colleagues are computers. You would of course instinctively mistrust clinicians who always know the answer without consulting the information grid, and patients often choose to be the team leader. Keyboards are banned as harmful and can be found in museums, next to punch cards and spittoons. The health record is a direct multimedia history of conversations, and a software agent is its curator. For the still cognitively limited clinician, your earring whispers your patient's name when you meet.

More importantly, in 2020 the health system in most nations will have to treat proportionately more people, with more illness, using relatively fewer tax dollars and workers.1 Given that commentators today are alarmed at the current strains on the health system, we have to assume that by 2020 the healthcare systems in most nations will therefore either have somehow transformed substantially or will have failed. If health care is to flourish in the coming setting of diminished resources and increased demand, then it will do so because we have explicitly designed and implemented new systems of care that are fundamentally sustainable. Given the likely enormity of that task, it may require nothing less than the reinvention of health care.

Many of the innovations needed for this reinvention are still unimagined today, but we can predict some of what must come to pass. In …

View Full Text

Log in

Log in through your institution


* For online subscription