Peel argued that people and organizational issues are more important than information technology ones, and that these issues are becoming even more complex as organizational boundaries expand across institutional, geographic, and even national boundaries. Dowling focused on global issues by discussing macroergonomic systems and described major trends that are converging to change how health care services are formed transnationally. He argued that while we can ship technology internationally, because processes and cultures differ, technology transfer is not successful until process and people differences are taken into account. Because the person is the only thing in common across boundaries, he, like Brennan advocated re-architecting systems around the person. Friedman emphasized the theme of culture differences, focusing on IT leadership within an institution.
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Brennan spoke about how the traditional roles of patients, consumers, businesses, and payers are giving way to new models of interaction, with traditional institutional walls being replaced by dynamic alliances that vary by time and duration. She emphasized the need to provide support for smart patients through patient-centered systems and consumer health informatics. The informatics tools of the future, she argued, will, of necessity, compensate for and capitalize on the fluid boundaries we are seeing in health care and require reformulation of concepts such as data ownership, the rights of access, and accountabilities for information. Dowling focused on macroergonomic systems and described two major trends that are converging to changing how health care services are formed. Second, is the growing demand for health care and related services due to the world-wide increase in peoples expectations for rapid advances in health and genetic interventions and to demographic shifts such as aging.