The Role of Expectations in System Innovation: The Electronic Health Record, Immoderate Goal or Achievable Necessity?

We critically assess expectations in radical system innovation from the point of view of their "moderateness", i.e. whether alternative scenarios have been properly considered, and whether counterarguments have been addressed. We use the case of the planning of the Dutch Electronic Health Record (EHR) to illustrate the role of immoderate expectations and their underlying assumptions. By discussing these assumptions in the light of contested issues in international literature, we uncover the uncritical reception of innovations like the EHR, and their potential consequences. We show that certain relevant aspects of academic critique are barely voiced in the political debate. Our analysis can be connected to expectations in innovation in general, in particular those involving ICT, such as expecting to deal with "ideal users", to be able to take information out of its original context, to achieve cost-efficiency by automation, and to overcome human errors by technology. Based on our observations, we plead for a more realistic view of innovation, in which immoderate expectations can to a certain extent be "unpacked" without falling back to essentialist claims.