Even in a “socialist” healthcare system like Canada’s where they have the authority and freedom to command, they have failed to implement electronic health records from the top down.
I think this mostly stems from the level of waste and fraud that happens in government, but also has much to do with the fact that healthcare IT simply sucks. It’s built by people who don’t understand simplicity nor can they imagine anything other than Windows 95. It’s a shame…
Britain has the same problem. They’d like to establish a national Health IT platform to connect hospitals and doctor practices but they simply can’t politically do it.
Hence the problem with the top down approach.
Meanwhile, 300 million people are now on Facebook. It grew organically from the bottom up because it was useful, easy to use, fun, and free.