Healthcare is where digitalisation goes to be humbled. A retrospective on thirty years of hospital IT at Berlin's Charité, published by heise, makes the point with three objects: a digital strategy, the Epic debate, and a fax machine.
The strategy is the easy part, and every large hospital has one. The promise is familiar — a unified patient record, data that follows the patient, clinicians freed from paperwork. Delivery is where the record bends: legacy systems that cannot be retired because something depends on them, interfaces nobody fully documented, and a purchasing cycle long enough for the technology to change twice.
The Epic debate is the sharpest expression of the choice hospitals now face. Buying from a dominant US electronic-health-record vendor promises integration and a modern platform; it also means a long, expensive migration, deep dependence on a single supplier, and workflows designed around a different health system's assumptions. Going it alone preserves autonomy and invites a decade of integration work. Neither answer is cheap, which is why the argument keeps recurring rather than resolving.
And then there is the fax machine, the emblem of it all. Fax survives in hospitals not from nostalgia but because it is universal, legally accepted in many jurisdictions and requires no shared platform. Every attempt to replace it runs into the same wall: the replacement has to work between every sender and receiver, not just inside one institution. That is a governance problem wearing a technology costume.
The lesson from thirty years is not that hospitals are bad at technology. It is that healthcare digitalisation is a coordination problem at least as much as an engineering one — and coordination across hundreds of institutions, vendors and regulators is exactly the kind of work that does not fit on a strategy slide.
Caveat: this reading draws on heise's retrospective and on well-documented, sector-wide patterns; specific claims about Charité's current systems should be checked against the original report.
