Despite initiatives and actions, only minor steps towards better communication systems have been achieved in healthcare. We examine this phenomenon empirically through three Norwegian healthcare projects, all of which started in 2005. The projects were initiated and funded by the Norwegian government and were aimed at establishing inter-organizational integration in healthcare. We examine the nature of these projects, and elaborate on how they tended to escalate and increasingly become enmeshed with each other. The top-down approach, with a high degree of requirement specification up front, creates a large gap between the different stakeholders involved. As an alternative, we propose a more restrained strategy in line with the information infrastructure concept: development in an inter-organizational setting must be carried out in small steps and with substantial influence by users and vendors.