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One of the continuing debates that occur around health informatics is whether it does any good at all, and how benefits should be assessed.
The RCT model, viewing Health IT as an intervention (see for example ), may be appropriate in some cases. But often Health IT projects cannot easily be assessed in this way.
The paper by Cullen et al in this issue attempts to assess the cost-benefit relationship for telecare. One of the key points is that choosing the correct scale to base your assessment on is vital. Many IT projects involve extra spending in some areas, both initially and during the life of the system, but the benefits may not return to the same funding stream.
At a smaller scale, a hospital using electronic maternity bookings as described by Patterson et al may expect to identify their own costs, but benefits in terms of efficiency and convenience may not be easily captured. Again in this case, a clinical trial may not be the appropriate method of evaluation.
Finally a system that is still at the prototype stage is not likely to be able to be formally assessed at all, except in terms of whether it performs its required functions. The paper on RFID approaches to reducing drug dispensing errors by Houliston et al is in this category. IT developers are familiar with the situation where a system does exactly what it is asked to do, but does not solve the problem it was developed for, or causes a different one!
All these papers describe systems or approaches in the early stages of development or use. This is one of the functions of the Journal - to allow the wider community to see what health informatics workers are getting up to, and see where things may be going.
 Wagner PJ, Dias J, Howard S, Kintziger KW, Hudson MF, Seol YH, et al. Personal health records and hypertension control: a randomized trial. Journal of the American Medical Informatics Association. 2012;19(1):Epub ahead of print.