Hak Pak Sak

Stephen Lewis on Infrastructure, Identity, Communication, and Change

More Balkan Lessons: Health Care Data and the Benefits of Dog-Eared Files and Messy Desks

Posted by Stephen Lewis on August 19, 2007

One of the frustrations of working outside of the US on and off for much of my life is that Americans often react with irritation or hostility when I describe to them the benefits of “Big Government” in European social democracies. It seems beyond the comprehension of many Americans that Western European countries have actually developed and maintained powerhouse economies while also attending to an ethos of social responsibility and egalitarianism — to paraphrase the tone of Bush and Co.’s Iraq War rhetoric: How could cowardly, self-indulgent Europe surpass the world’s number-one democracy? Now, to their benefit and credit, Americans are beginning to wake up to the fact that they have cheated themselves and allowed themselves to be cheated, and that other nations have surpassed the US when it comes to taking care of their citizens. Michael Moore’s new film “Sicko” makes this point with Moore’s usual delightful bombast while the New York Times sums up the sorry state of affairs in this more somber editorial.

Health Care Chaos and the Democratization of Records

In a recent posting on the implications of the ever-narrowing gap between the US dollar and (!) the Bulgarian Lev, I described some facets of the economy and tone of post-communist Bulgaria and possible lessons to be learned from transformations and chaos in this small Balkan Republic over the last two decades, i.e. since the implosion of Communism. In the posting, however, I neglected to mention health care. Depending on which side of their country’s deepening gap between rich and poor Bulgarians fall, they have private or state insurance and visit expensive medical and dental clinics or are served by the country’s rank-and-file GPs and dedicated but overworked and ill-equipped public hospitals.

The single, but admittedly accidental, benefit of this unmanaged flux is that, for the moment at least, many Bulgarians have control of their own medical data, albeit without the adequate tools to administer them. Most Bulgarian doctors have neither the desire nor space to store records. Thus, their patients carry their own x-rays with them and pick-up and store their own blood-test and lab results. As a result, patients have a full set of printouts, film, and hands-scrawled charts with them most of the time — even if carried in dog-eared folders and stored on messy desk tops and in jumbled desk drawers. If they are interested and capable, and have sufficiently confrontational personalities, possession of such documents give them an inside track into understanding and maybe even managing their own conditions and treatment. Thus, once again, accidental circumstances in Bulgaria point to solutions for problems Americans face, in this case getting medical records out of the file cabinets and off the desks of doctors and, even if in duplicate, into the hands of the patients to whom they rightfully belong. The next step of course would be to set advanced information technology to work to support patients in setting data to work for their benefit and the potential benefit of others. The New York Times editorial linked to above underscored the urgency of this issue:

“Shockingly, despite our vaunted prowess in computers, software and the Internet, much of our health care system is still operating in the dark ages of paper records and handwritten scrawls. American primary care doctors lag years behind doctors in other advanced nations in adopting electronic medical records or prescribing medications electronically. This makes it harder to coordinate care, spot errors and adhere to standard clinical guidelines.”

Not Just the Province of Giants

Some days later, the Times reported that Google and Microsoft have entered into the medical information management fray. But, as I wrote following a meeting with Vendor Relations Management activists at the Oxford Internet Institute back in July, there are numerous opportunities for grass-roots information projects (in this case a proposed community-based project serving diabetics in the UK) that can turn us all into managers rather than victims of medical care. We needn’t wait for industry giants, even if well-willing, to do the job.

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