The formation of Local Health Integration Networks (LHIN) in Ontario marks an important new chapter in the organization and delivery of health care in Canada’s largest province. Although technology and the emergence of e-health are important drivers of this experiment in regionalization, governance will ultimately be the key determinant of success or failure.

Why create a set of LHINs in the first place? First, size matters. Ontario is larger both geographically and demographically than most countries, including those of Scandinavia that are often regarded as e-government leaders. In these Nordic countries, it is not the national government that is primarily responsible for health care – it is the regions. The Ontario case is thus analogous.

Secondly, the scope of innovation and interoperability also matters. While Ontario has an e-health strategy managed from within a Toronto-based ministry, the actual deployment of new technologies and the benefits derived from new collaborative mechanisms are inherently more localized. As much as e

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