In his latest report on the development of the Connecting for Health e-health system in England, Sir Derek Wanless details three obstacles for improving productivity in healthcare with IT support:

• First is a failure to develop an IT strategy where the benefits received are aligned with the costs.

• Wanless then cites the lack of an audit process he assumed in his 2002 report would take place, saying, "There seems a real risk that the costs and benefits of the National Program for IT will never be accurately assessed."

• The creation of supplier monopolies in key areas of the program is the third risk factor and "may turn out to be the most important," he says.

He sees the NHS model of lead consortiums as restricting what could be a "healthy, competitive market for IT goods and services."

- John Brosky, European Editor