In this introduction we summarize the contributions to the Fourth International Conference Information Technology in Health Care: Socio-technical Approaches. We argue that putting to use information systems in health care is a difficult and winding road. Systems may even compromise instead of improving patient safety. Designing and implementing systems requires a thorough understanding of the context in which technology is being used. But this understanding should also lead to better design and implementation methods. Therefore this conference wishes to address the challenges of safe systems and patient safety, ten years after the publication of the landmark reports on human error and quality of health care by the Institute of Medicine.