The inability of ministers, public servants, managers, IT experts and health professionals to move the health sector into the modern world constitutes an important systemic failure.

This week, I made an appointment to be treated at a large skin clinic which is very much at the "business end" of medical practice. The appointment book was computerised but the receptionist still wrote out a reminder card. The Medicare rebate could be claimed electronically from the surgery but only if I had available my bank account and BSB details; otherwise a cheque would be sent in the time-honoured way.

Although a growing minority of doctors now takes notes electronically, for the convenience of their practices, an integrated electronic health record that draws on the work of many different health professionals is still a long way off. That's because it's not in anyone's immediate interests to put in the effort. To doctors and other treating professionals, it often seems like a cost to them so that others can benefit. To senior health policy-makers, it is never as urgent a priority as providing better and more accessible clinical services or responding to the latest crisis.

My first scripted speech as health minister, in November 2003, set a five year deadline for an integrated electronic health record and for paperless Medicare claiming.