the Ghanaian capital of Accra only 5.3% of Ghanaians had access to broadband in May 2011. A year later little has changed. The buzz of dialup modems can still be heard in street-side cybercafes. Even so, says Ghana Health Service systems analyst Dominic Atweam, the country has detailed plans for the introduction of digital health services and may well be a step ahead in its m-health progress by virtue of the widespread use of mobile telephones. The introduction of e-health services--digitally-based, networked, Internet-aided, rapid transfer of medical and scientific information for clinical, research and convenience purposes--is already under way in many with mixed results. the United Kingdom of Great Britain and Northern Ireland, the National Health Service started implementing electronic medical records a decade ago; its US$1.5 billion programme has been marked by lengthy debate over the scope of e-health, the degree of centralization and who would be responsible. With the world's population recently hitting the seven billion mark, digital systems are not just vital but inevitable for managing health, says International Telecommunications Union secretary general Hamadoun Toure. Information and communications technology will play a key role in delivering health care in the future--that's true in developing and in developed countries, Toure says. In the developed world the driver is the ageing the developing world it is a rapidly growing young population. [ILLUSTRATION OMITTED] Digital health services are under development--or already in service--for a vast array of purposes. These include consumer services for everyday patient use and clinical systems and specialists, to exchange advice or teach over long distances. E-health services and tools are generally web-enabled and are built for standard uses on personal computers or laptops and, increasingly, for mobile devices, smartphones and tablets. All must wrestle to some degree with the complex issue of interoperability to gain wider and better use in the future: e-health programming requires crossing boundaries in technical, organizational and cultural aspects and it's vital to have systems that communicate clearly and easily with each other. There are communication blocks at every turn: in semantic ways, in terms of vast areas of terminology, language, definition, meaning and context that must be negotiated; and also in terms of raw technology, of operating systems and programmes and filing nomenclatures that must work smoothly together. The lack of interoperability is an entrenched problem that must be taken into account in every e-health project, says Zoi Kolitsi, an e-health strategist based in Athens, Greece. Pille Kink, an official at the Estonian Ministry of Social Affairs in Tallinn and head of the country's e-health department, is proud of the progress made in her small Baltic state but not completely satisfied. 2005 a coalition of private and state health-related institutions got together to launch the Estonian eHealth Foundation. It laid the groundwork for the country's centralized electronic health record system by tying it to the nation's electronic identification network. Electronic identification, a unique number assigned to every citizen according to law, has gained widespread acceptance; foreign nationals are also assigned so-called e-IDs, and so many issues plaguing the introduction of consumer e-health services are eased in Estonia. Germany, the United Kingdom and the United States of America and other wealthy there is cultural and historical resistance to heavy centralization of record-keeping and privacy concerns about the potential intrusion of government or business into sensitive personal documents. the developing world, a lack of electronic infrastructure might be a drag on effective digital record-keeping. …