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But going beyond technical "solutions" and engaging with these language games would clash together with the bounded rationality that policymakers generally employ to make their eHealth programs manageable. This may perhaps explain their limited and contained response towards the nuanced messages of in-depth case study reports. Conclusion: The complexity of contemporary overall health care, combined with the multiple stakeholders in large technology initiatives, signifies that national eHealth applications call for considerably additional pondering through than has sometimes occurred. We need fewer grand plans and more understanding communities. The onus, thus, is on academics to create methods of drawing judiciously around the richness of case studies to inform and influence eHealth policy, which necessarily occurs within a simplified decision environment. Key phrases: eHealth, policymaking, case study, ethnography, evaluation, Wittgenstein, sensemaking, mastering community.eHealth Policy: The Canon of HistoryThose who ignore history are doomed to repeat it. --George Santayana (1863?952)National eHealth applications hardly ever unfold as predicted, especially when cautiously planned out in title= f1000research.9271.1 advance. Naturally, that is due to the fact they are complicated and title= s12916-016-0650-2 unpredictable. But policymakers normally persist in considering that points will go better next time. Their hubris has reached a level that deserves to be researched in its own proper. To that end, this article argues that lessons are seldom learned from national eHealth applications for the reason that insufficient value is placed on in-depth case studies, and it makes this case on philosophical as an alternative to methodological grounds. We propose that national eHealth programs and, by extension, other complicated technologies projects with a number of stakeholders and interdependencies could usefully be reconceptualized as Wittgensteinian language games.Why National eHealth Programs Require Dead PhilosophersThe United States' 2009 Wellness Information and facts Technologies for purchase Lonafarnib Economic and Clinical Health (HITECH) Act allocated up to 27 billion for the adoption and "meaningful use" of electronic health records by physicians and hospitals in between 2011 and 2015 (Blumenthal and Tavenner 2010). Australia's federal price range for 2010/2011 included A 466.7 million (US 473 million) for the design, creating, and title= JVI.00458-16 national rollout of a personally controlled electronic health record (PCEHR) (Westbrook and Braithwaite 2010). By 2010, Canada's Health Infoway implementation plan had been allocated C 2.13 billion (US 2.16 billion) (Whitt 2010). In some ways, Engl.Generalization (as with experiments) nor theoretical generalization (as with multisite case comparisons or realist evaluations). But they do supply the facility for heuristic generalization (i.e., to attain a clearer understanding of what's going on), thereby enabling additional productive debate about eHealth programs' complex, interdependent social practices. A national Address correspondence to: Trisha Greenhalgh, Yvonne Carter Building, 58 Turner Street, London E1 2AB (e-mail: p.greenhalgh@qmul.ac.uk).The Milbank Quarterly, Vol. 89, No. 4, 2011 (pp. 533?63) c 2011 Milbank Memorial Fund. Published by Wiley Periodicals Inc.T. Greenhalgh, J. Russell, R.E. Ashcroft, and W. ParsonseHealth plan is best conceptualized not as a blueprint and implementation program for a state-of-the-art technical program but as a series of overlapping, conflicting, and mutually misunderstood language games that combine to produce a scenario of ambiguity, paradox, incompleteness, and confusion. But going beyond technical "solutions" and engaging with these language games would clash with all the bounded rationality that policymakers ordinarily employ to produce their eHealth programs manageable.