For the first twenty years of my career, I worked in the health care field, as a clinical psychologist in a public mental health center and in private practice. In the late 70s/early 80s, I was involved in acquiring, installing and running what were then called management information systems in health care facilities, primarily in hospitals. After a decade of working in that world, I fled, screaming, in an attempt to save what was left of my sanity. The process by which hospitals and other facilities choose and implement information systems was fraught with politics, favoritism and outright corruption. Granted, those were the early days of automated medical records but personal experience (my own and Doc's) tells me that the ground on which these decisions are made are no more patient-centric today than they were then. Health care service providers, especially those on the front line of patient care - attending physicians, nurses, aides, therapists - are so overwhelmed by the patient load that the prospect of participating in the design, selection and implementation of new systems reduces them to tears. These are people who have been jerked around so often by system vendors, many selling rare oils derived from reptiles, that they are loath to consider another time around the wheel. A patient-centric health care information system is an absolute necessity in America. My experience leads me to be very pessimistic about its prospects.