Health Information Technology (HIT) is sometimes seen as a silver bullet for human resource, medical and economic challenges facing health systems. The evidence supporting widespread use of HIT is, however, still patchy and inconsistent. In this Perspective piece, we seek to interpret and draw key lessons from a selection of illustrative trials in developed countries with robust health-care settings in respiratory medicine that failed to demonstrate effectiveness, and offer suggestions to maximise the chances of success in subsequent HIT deployments. Particularly low- and middle-income countries, with relatively weak health infrastructures and limited health care, propose considerable room for improvement. Early experiences of studying HIT thus far in high-income country settings suggest that this process should preferably begin with trials of low-cost, well-established technologies in patient groups with a moderate burden of disease while carefully evaluating patient safety.